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Name  of  Book  and  Volume, 


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University  of  California. 


THE  MEDICAL  LIBRARY 


v.  .i .    F<  >  r  lui  I:A  r  i  >.    vi .  i  >. 

Of  San   Francisco. 

PRESENTED  BY  MRS.  AND  MISS  FOURGEAUD. 
/"/:/>•  if  i   i  in.  is;.;. 


University  of  California  •  Berkeley 


Dunglisorts  American  Medical  Library. 


THE 


SANATIVE   INFLUENCE 

OF 

CLIMATE: 

WITH   AN  ACCOUNT   OF 

THE  BEST  PLACES  OF  RESORT  FOR  INVALIDS 

IN  ENGLAND,  THE  SOUTH  OF  EUROPE,  &c. 


BY 
SIR  JAMES  CLARK,  BART.,  M.  D.,  F.  R.  S. 

PHYSICIAN   IN  ORDINARY   TO  THE  QUEEN,   AND  TO  THE   PRINCE   ALBERT. 


PROM  THE  THIRD  LONDON  EDITION. 


PHILADELPHIA: 

PUBLISHED  BY  A.  WALDIE,  46  CARPENTER  STREET. 

1841. 


ADVERTISEMENT 

TO 

THE    THIRD   EDITION 


For  the  present  edition,  this  work  has  been  almost  en- 
tirely re-written,  and  whatever  appeared  not  directly  to 
the  purpose  has  been  omitted,  in  order  to  make  room  for 
the  consideration  of  several  new  subjects,  and  the  introduc- 
tion of  notices  of  some  places  not  previously  described. 

In  an  appendix,  a  brief  account  has  been  given  of  the 
climates  of  our  colonies  in  the  southern  hemisphere  ;  and, 
in  another  short  appendix,  a  few  remarks  have  been  made 
on  the  application  of  some  of  the  most  efficient  mineral 
waters  of  the  Continent  to  the  alleviation  and  cure  of  the 
principal  diseases  treated  of  in  this  volume.  The  meteoro- 
logical tables  have  received  several  important  additions  and 
amendments. 

Since  the  publication  of  the  last  edition,  I  have  con- 
tinued to  receive  from  numerous  medical  friends,  and 
others,  who  had  resided  some  time  abroad  for  their  health, 
the  most  satisfactory  assurances  of  the  accuracy  of  my  de- 
scriptions of  the  different  climates,  and  their  influence  on 
disease.  My  own  additional  experience  has  been  in  per- 
fect accordance  with  this  testimony.  Madeira  is  almost 
the  only  place  respecting  which  statements  do  not  quite 
agree ;  but  after  carefully  weighing  all  the  information 
which  I  have  received,  I  have  not  found  sufficient  reason 
to  change  my  opinion  of  the  climate  of  that  island. 

For  the  valuable  new  matter  which  enriches  this  edition 
of  my  work,  I  am  under  obligations  to  various  friends,  to 
whom  particular  acknowledgments  are  made  at  the  proper 
places.  To  the  kindness  of  my  friend  Dr.  Davy,  I  am 
indebted  for  the  advantage  of  perusing  his  interesting 

1* 


IV  ADVERTISEMENT. 

work,  still  in  manuscript,  on  the  military  stations  in  the 
Mediterranean.  The  work  unfortunately  reached  me  at 
too  late  a  period  to  allow  me  to  avail  myself  of  the  infor- 
mation contained  in  it ;  but  I  had  the  satisfaction  to  find 
that  Dr.  Davy's  views  regarding  the  Mediterranean  climate 
are  in  perfect  accordance  with  my  own.  Respecting  the 
infrequency  of  pulmonary  diseases  among  our  troops  sta- 
tioned in  the  Ionian  Islands,  compared  with  the  other 
Mediterranean  stations,  Dr.  Davy's  experience  agrees  with 
the  conclusions  drawn  in  the  Statistical  Reports  on  the 
Health  of  the  Army.  To  Major  Tulloch,  who  has  so  ably 
drawn  up  these  reports,  I  take  this  occasion  to  express  my 
obligations  for  his  readiness  at  all  times  in  supplying  me 
with  information  on  the  climates  of  our  different  colonies, 
and  the  health  of  our  troops  stationed  there.  To  my  friend, 
Dr.  Martin,  of  Undercliff,  I  am  also  greatly  indebted  for 
his  assistance  in  revising  and  extending  the  meteorological 
tables. 

J.  C. 
London,  May  \st>  1841. 


PREFACE 

TO 

THE  FIRST  EDITION. 


It  is  nearly  nine  years  since  I  published  a  small  volume  of 
"  Notes"  on  the  Climate  and  Medical  Institutions  of  France  and 
Italy.  This  met  with  a  very  favourable  reception ;  more,  I  be- 
lieve, from  the  want  of  such  a  work,  than  from  any  merit  it  pos- 
sessed. Since  that  time  I  have  had  ample  opportunities  of  observ- 
ing the  nature  of  the  climate  of  the  South  of  Europe,  and  its 
effects  on  disease  :  and  during  the  three  years  which  have  elapsed 
since  my  return  from  the  Continent,  I  have  endeavoured  to  make 
myself  acquainted  with  the  milder  parts  of  England,  with  the  view 
of  ascertaining  their  respective  merits,  and  of  comparing  them  with 
the  climates  of  the  south.  The  present  work  may,  therefore,  be 
considered  as  exhibiting  the  result  of  much  more  extended  obser- 
vation and  experience  than  its  predecessor. 

But  although  I  have  endeavoured  to  take  a  more  comprehensive 
and  philosophical  view  of  my  subject,  I  wish  this  work  still  to  be 
regarded  as  an  Essay,  which  future  and  yet  more  extensive  obser- 
vation only  can  perfect.  If,  however,  it  shall  be  found  that  I  have 
investigated  the  subject  faithfully  and  closely,  as  far  as  I  have 
gone,  and  if  the  results  of  rny  researches,  and  my  experience;  now 
recorded,  shall  prove  useful  to  future  inquirers,  and  serve  as  a 
guide  to  my  medical  brethren  in  the  application  of  climate  to  the 
prevention  and  cure  of  disease,  I  trust  I  may  be  considered  as  hav- 
ing accomplished  all  that  could  be  reasonably  expected  of  me,  in 
an  inquiry  of  such  extent  and  difficulty. 

The  following  work  is  divided  into  two  parts.  In  the  first,1  I 
have  endeavoured  to  determine  the  general  physical  characters  of 
the  milder  climates  of  England,  and  of  the  south  of  Europe — to 
point  out  the  manner  in  which  the  climate  of  different  places 

1  The  order  of  the  two  parts  has,  in  the  present  edition,  been  reversed. 


VI  .,         PREFACE. 

resorted  to  by  invalids  is  modified  by  local  circumstances  ;  and  to 
compare  these  places  relatively  to  their  influence  on  disease. 

This  part  is  illustrated  by  a  series  of  meteorological  tables 
(which  will  be  found  in  the  Appendix)  more  comprehensive  and 
perfect,  I  believe,  than  have  before  been  published  ;  and  for  the 
construction  of  which  I  am  indebted  to  the  kindness  of  my  friend 
Dr.  Todd. 

In  the  second  part,  I  have  given  some  account  of  the  principal 
diseases  which  are  benefited  by  a  mild  climate.  This  I  found  to 
be  unavoidable;*  it  being  impossible,  otherwise,  to  give  precise 
directions  for  the  application  of  particular  climates  to  the  cure  of 
particular  diseases — and  much  more  so  to  their  varieties  and  com 
plications. 

In  my  endeavours  to  distinguish  the  characters  of  some  of  these 
diseases  in  relation  to  the  effects  of  climate  upon  them,  it  may  ap- 
pear that  I  have  been  unnecessarily  minute  ;  but  I  have  made  such 
distinctions  only  as  my  experience  warranted ;  and  I  have  made 
them,  because  I  feel  satisfied  that  without  strict  attention  to  distinc- 
tions of  this  kind,  climate  can  never  be  successfully  applied  as  a 
remedial  agent. 

In  treating  of  two  diseases  (or  rather  classes  of  diseases)  I  have 
gone  more  into  detail  than  the  nature  of  my  work  may,  at  first 
sight,  appear  to  require;  but  the  great  importance  of  these  affec- 
tions, their  extreme  frequency  in  this  country,  and  the  close  rela- 
tion in  which  they  stand  to  climate,  considered  as  a  remedy,  ap- 
peared to  me  to  claim  for  them  all  the  consideration  which  I  have 
bestowed  upon  them. 

The  diseases  to  which  I  allude  are  consumption,  and  disorders 
of  the  digestive  organs.  Under  this  last  title,  I  comprehend  the 
various  affections  designated  by  the  terms  "  indigestion,"  "  bilious 
complaints,"  &c.  In  the  article  on  consumption,  I  have  endea- 
voured to  show  that  the  disordered  states  of  the  stomach  are  inti- 
mately connected  with  the  origin  of  diseases  of  the  chest,  and  with 
tuberculous  affections  generally.  On  this  account  alone  disorders 
of  the  digestive  organs  would  claim  particular  notice  in  a  work  of 
this  kind ;  but  on  their  own  account  they  are  no  less  entitled  to 
attention,  seeing  the  amount  of  suffering  and  of  evil  which  they 
produce,  and  the  great  benefit  which  I  have  shown  may  be  derived 
from  change  of  air  and  of  climate  in  the  treatment  of  them. 

With  respect  to  the  subject  of  consumption,  it  will  probably  be 
considered  the  most  legitimate  of  any,  in  a  work  treating  of  the 
effects  of  climate.  On  this  occasion,  I  have  directed  my  inquiries 


PREFACE.  Vll 

chiefly  to  the  causes  and  origin  of  this  fatal  disease,  with  the  view 
of  establishing  rules  for  its  prevention ;  being  well  satisfied  that  it 
is  only  by  a  knowledge  of  the  causes  which  lead  to  it,  and  by 
directing  our  efforts  to  counteract  them,  that  we  shall  be  able  to 
diminish  the  ravages  of  consumption.  On  this  most  important  in- 
quiry, therefore,  I  have  entered  as  fully  as  the  nature  of  my  work 
would  admit,  and  have  endeavoured,  to  the  best  of  my  abilities,  to 
fill  np  the  blank  which  has  been  left  in  the  natural  history  of  con- 
sumption— that,  namely,  between  a  state  of  health,  and  of  esta- 
blished and  sensible  disease  of  the  lungs. 

I  feel  convinced  that  by  adopting  such  a  system  of  management, 
from  early  infancy,  as  I  have  laid  down  in  the  following  pages,  a 
great  improvement  might  be  effected  in  the  general  health  of  many 
among  the  higher  and  middle  classes  of  society  in  this  country. 
The  children  of  delicate,  and  even  of  diseased  parents,  might,  by 
proper  care,  be  reared  so  as  to  overcome,  in  a  large  proportion  of 
cases,  their  hereditary  disposition  to  disease.  The  ultimate  effect 
of  this,  in  diminishing  the  vast  and  increasing  extent  of  hereditary 
diseases,  need  not  be  pointed  out. 

Instructions  respecting  the  necessary  preparation  of  invalids  for 
a  change  of  climate — for  their  guidance  during  the  journey,  and 
during  their  residence  abroad,  will  be  found  as  minutely  laid  down 
as  the  nature  of  the  subject  would  admit.  During  my  residence 
on  the  Continent,  I  found  these  matters  greatly  neglected.  They 
are,  however,  of  the  very  first  consequence  to  invalids,  as  without 
attention  to  them,  the  best  climate  will  be  productive  of  little 
benefit. 

It  was  originally  my  intention  to  have  added  a  third  part,  giving 
some  account  of  the  principal  mineral  waters  of  the  Continent  ; 
but  I  found,  on  arranging  my  materials  on  this  subject,  that  I  could 
not  have  condensed  them  sufficiently  for  this  purpose,  without 
greatly  diminishing  their  value.  I  have  therefore  resolved  to  lay 
them  before  the  public  in  a  separate  volume  ;  and  have  satisfied 
myself,  on  the  present  occasion,  with  merely  indicating  the  mineral 
waters  most  suitable  to  the  different  diseases  treated  of.  This  class 
of  remedies  will  be  found  to  co-operate  powerfully  with  a  mild 
climate  in  the  removal  of  many  chronic  disorders. 

This  is  the  proper  place  to  notice  the  kind  and  liberal  assistance 
which  I  have  received  from  many  friends,  while  engaged  in  col- 
lecting materials  for  this  work.  To  Drs.  Heineken  and  Renton  of 
Madeira,  Dr.  Skirving  of  Nice,  Dr.  Peebles  of  Rome,  and  Dr.  Play- 
fair  of  Florence,  I  am  indebted  for  much  valuable  information. 


Viii  PREFACE. 

By  the  assistance  chiefly  of  the  two  first  named  gentlemen,  I  have 
been  enabled  to  give  more  precise  information  respecting  the  climate 
of  Madeira,  and  its  influence  on  disease,  than  has,  I  believe,  been 
previously  laid  before  the  public.  From  Dr.  Forbes  of  Chichester, 
Dr.  Lempriere  of  Newport,  and  Dr.  Down  of  Southampton,  I  have 
received  much  information  respecting  several  of  the  English  cli- 
mates. But  the  gentleman  to  whom  I  am  indebted  above  all 
others,  is  my  esteemed  friend,  Dr.  Todd  of  Brighton,  who  has,  with 
one  or  two  exceptions,  resided  for  some  time  at  all  the  places  on 
the  Continent  noticed  in  the  following  pages,  and  who  has  unre- 
servedly communicated  to  me  the  result  of  his  observations  and 
extensive  experience;  so  that  there  is  scarcely  an  article  in  the 
work  which  has  not  been  improved  by  his  suggestions.1  I  also 
avail  myself  of  the  present  occasion,  with  much  pleasure,  to  ac- 
knowledge the  information  which  I  liberally  received  from  my 
continental  brethren.  To  my  valued  friends,  Professor  De  Mat- 
thaeis  of  Rome,  Dr.  Lanza  of  Naples,  Dr.  Mojon  of  Genoa,  and 
Professor  Grotanelli  of  Sienna,  I  am  more  particularly  indebted  in 
this  way.  Indeed,  the  friendly  and  liberal  intercourse  which  I  en- 
joyed, while  on  the  Continent,  with  my  professional  brethren,  is 
one  of  the  circumstances  connected  with  my  residence  abroad,  the 
retrospect  of  which  affords  me  the  greatest  satisfaction.  I  can 
assure  such  of  the  profession  of  this  country  as  may  visit  the  Con- 
tinent, that  they  will  very  generally  experience  there  the  greatest 
facility  in  prosecuting  their  professional  researches ;  and,  I  take 
leave  to  add,  that,  if  they  carry  with  them  minds  free  from  preju- 
dice, and  a  sufficient  degree  of  practical  knowledge  to  enable  them 
to  profit  by  what  they  observe,  they  will  not  fail  to  improve  them- 
selves. 

I  hope  it  will  be  found  that  I  have  succeeded  in  throwing  some 
light  on  the  obscure  subject  of  the  influence  of  climate  on  human 
health,  and  on  the  application  of  it  to  the  treatment  of  disease.  I 
would  also  hope,  from  the  minute  manner  in  which  I  have  de- 
scribed the  characters  of  the  different  climates  frequented  by  inva- 

1  By  Dr.  Todd's  death,  which  occurred  last  August,  (1840,)  the  author 
of  this  work  has  lost  a  much  valued  friend,  and  medical  science  one  of  its 
most  ardent  cultivators.  Dr.  Todd  had  long  been  engaged  in  a  series  of 
researches  on  some  of  the  most  important  points  of  Physiology  and  Patho- 
logy ;  and  the  collection  of  microscopical  preparations  which  he  has  left, 
shows  what  Dr.  Todd  might  have  accomplished,  had  his  life  been  spared  a 
few  years  longer.  The  collection  has  been  purchased  by  the  College  of 
Surgeons,  to  add  to  the  Hunteriac  Museum. 


PREFACE.  IX 

lids,  and  the  care  with  which  1  have  indicated  the  nature  of  the 
diseases  benefited  by  them,  that  I  have  gone  far  to  correct  many 
of  the  erroneous  opinions  which  have  hitherto  existed  on  these 
subjects.  However  this  may  be,  I  do  at  least  anticipate  this  good 
effect  from  my  labours— that,  for  the  future,  those  patients  only 
will  be  sent  abroad  whose  cases  afford  a  reasonable  prospect  of 
benefit  from  such  a  measure  ;  and,  that  the  practice  of  hurrying 
out  of  their  own  country  a  class  of  invalids,  whose  sufferings  can 
only  be  thereby  increased,  and  their  lives  shortened,  will  no  longer 
be  sanctioned,  but  that  such  persons  may  be  allowed,  henceforth, 
to  die  in  peace  in  the  bosom  of  their  own  families. 

As  I  anticipated  that  the  following  work  would  be  perused  by 
many  persons  not  of  the  profession,  but  who  are  yet  deeply  inte- 
rested in  the  subject  of  climate,  in  relation  to  its  effects  on  disease, 
I  have  endeavoured  to  express  myself  in  as  plain  language  as  pos- 
sible; and  I  trust  t  have  succeeded  in  making  myself  intelligible 
to  the  generality  of  readers,  without  at  all  diminishing  the  utility 
of  my  book  to  the  members  of  my  own  profession.  It  has  been  my 
wish  to  lay  before  the  public  such  a  work  as  might  serve  at  once 
as  a  manual  to  the  physician,  in  selecting  a  proper  climate  for  his 
patient,  and  a  guide  to  the  latter  while  no  longer  under  the  direc- 
tion of  his  medical  adviser.  It  is  only  those  who  have  resided 
abroad,  and  have  mixed  much  with  that  numerous  class  of  our 
countrymen  who  travel  for  health,  that  can  know  how  very  much 
such  a  publication  is  wanted;  and  I  may  perhaps  be  permitted  to 
add,  at  the  same  time,  that  it  is  only  those  who  have  attempted  to 
compose  such  a  work  that  can  be  aware  of  the  difficulties  of  the 
task. 

London,  May  22,  1829. 


THE 


INFLUENCE  OF  CLIMATE, 

&C.      &C. 


INTRODUCTION. 

The  influence  of  climate  over  disease  has  been  long  established 
as  a  matter  of  fact,  arid  physicians  have,  from  a  very  early  period, 
considered  change  of  climate  and  change  of  air  as  remedial  agents 
of  great  efficacy.  This  opinion  is  supported  both  by  reason  and 
experience  : — it  is  reasonable,  for  example,  to  believe,  that  a  change 
of  residence  from  a  crowded  city  to  the  open  country,  or  from  a 
cold  exposed  part  of  the  country  to  a  warmer  and  more  sheltered 
situation — from  a  confined,  humid  valley,  to  a  dry  elevated  district, 
or  the  reverse,  would  produce  very  sensible  effects  on  the  living 
body  ;  and  we  find  by  daily  experience  that  such  is  the  case.  The 
marked  improvement  of  the  general  health,  effected  by  the  transi- 
tion from  the  city  to  the  country,  even  for  a  short  period,  is  matter 
of  daily  remark;  and  the  suspension,  or  even  cure,  of  various  dis- 
eases by  a  removal  from  one  part  of  the  country  to  another,  is  an 
occurrence  that  must  have  come  within  the  observation  of  every 
one.  It  may  suffice  to  mention  here,  in  reference  to  this  fact,  in- 
termittent fevers,  asthma,  catarrhal  affections,  hooping  cough,  dys- 
pepsia, and  various  nervous  disorders.  These  diseases  are  often 
benefited,  and  not  unfrequently  cured,  by  simple  change  of  situa- 
tion, after  having  long  resisted  medical  treatment;  or  they  are 
found  to  yield,  under  the  influence  of  such  a  change,  to  remedies 
which  previously  made  little  or  no  impression  upon  them. 

If  such  marked  effects  result  from  a  change  of  so  limited  a  nature 
as  has  just  been  noticed,  it  might  be  expected  that  a  complete 
change  of  climate,  together  with  the  circumstances  necessarily 
connected  with  it,  should  produce  still  more  important  results  in 
the  improvement  of  the  general  health,  and  in  the  alleviation  and 
cure  of  disease.  In  this  expectation  we  are  also  borne  out  by  ex- 
perience. 

Unfortunately,  however,  for  the  character  of  climate  as  a  remedy, 
it  has  too  often  been  resorted  to,  either  as  a  last  resource,  or  it  has 
been  misapplied  in  cases  wherein  it  would  otherwise  have  been 


12  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

capable  of  yielding  essential  service.  Patients,  who  really  might 
have  derived  much  benefit  from  change  of  climate,  have  too  often 
been  sent  abroad  without  proper  directions  regarding  the  situation 
most  suited  to  their  complaints,  and  altogether  uninstructed  re- 
specting various  circumstances,  a  due  attention  to  which  is  neces- 
sary to  give  full  effect  to  the  best  selected  climate. 

Under  such  circumstances,  it  need  not  excite  surprise  that  suc- 
cess has  not  more  generally  attended  the  practice  of  sending  inva- 
lids abroad  ;  nor  even,  that  the  result  should  have  been  such  as  to 
bring  the  remedy  into  discredit.  The  fault,  however,  is  to  be  sought 
for,  not  in  the  remedy,  but  in  the  manner  in  which  it  has  been  ap- 
plied. My  own  experience  has  been  sufficient  to  satisfy  me,  that, 
for  the  prevention  and  cure  of  a  numerous  class  of  chronic  diseases, 
we  possess  in  change  of  climate,  and  even  in  the  more  limited  mea- 
sure of  change  of  air  in  the  same  climate,  one  of  our  most  efficient 
remedial  agents  ;  and  one,  too,  for  which,  in  many  cases,  we  have 
no  adequate  substitute. 

On  the  Continent,  the  beneficial  effects  of  change  of  air  are  duly 
estimated  ;  and  the  inhabitants  of  this  country,  and  more  especially 
of  this  metropolis,  are  now  becoming  fully  sensible  of  its  value. 
The  vast  increase  in  the  size  of  our  watering  places,  of  late  years, 
and  the  deserted  state  of  a  great  part  of  London  during  several 
months,  are  sufficient  proofs,  not  to  mention  others,  of  the  increas- 
ing conviction  that,  for  the  preservation  of  health,  it  is  necessary 
to  change,  from  time  to  time,  the  relaxing,  I  may  say  deteriorating 
air  of  a  large  city,  for  the  more  pure  and  invigorating  air  of  the 
country.  This,  indeed,  is  the  best,  if  not  the  only  cure,  for  that 
destructive  malady,  which  may  be  justly  termed  cachexia  londi- 
nensis,  which  preys  upon  the  vitals,  and  stamps  its  hues  upon  the 
countenance  of  almost  every  permanent  resident  in  this  great  city. 
When  the  extent  of  benefit  which  may  be  derived  from  occasional 
change  of  air  both  to  the  physical  and  moral  constitution,  is  duly 
estimated,  no  person  whose  circumstances  permit  will  neglect  to 
avail  himself  of  it. 

But  to  be  beneficial,  the  remedy,  simple  as  it  appears,  must  be 
employed  with  judgment  and  discrimination.  In  that  numerous 
class  of  persons,  indeed,  who  are  merely  suffering  from  a  residence 
in  the  city,  without  any  decided  disease,  the  mere  change  to  the 
country  may  be  all  that  is  requisite  to  restore  their  health ;  it  is 
therefore  of  less  consequence  to  what  part  they  go.  But  the  case  is 
very  different  with  the  invalid  whose  sufferings  are  chiefly  refer- 
able to  some  particular  disease.  To  him,  the  selection  of  his  tem- 
porary residence  is  not  a  matter  of  indifference.  For  one  indi- 
vidual of  this  kind,  an  elevated  situation  and  a  dry  bracing  air,  will 
be  most  proper ;  a  sheltered  residence,  with  a  milder  air,  will  be 
suitable  to  another ;  while  the  sea-side  may  be  the  situation  indi- 
cated for  a  third.  In  like  manner  it  is  with  the  more  important 
measure  of  change  of  climate.  The  valetudinarian  whose  health 
is  deteriorated  by  severe  study  or  too  close  application  to  business, 


INTRODUCTION.  13 

and  to  whom  relaxation  of  mind  is  as  requisite  as  change  of  climate, 
may  generally  be  permitted  to  choose  the  situation  most  agreeable 
to  himself.  But  the  great  difference  which  exists  in  the  physical 
characters  of  the  climate  of  the  places  frequented  by  invalids  in  the 
South  of  Europe,  and  even  in  the  southern  parts — whether  interior 
or  sea-coast — of  our  own  island,  renders  the  selection  of  a  winter 
residence  a  matter  of  vital  importance  to  the  invalid  suffering  un- 
der formal  disease. 

This  is  a  subject  which  has  been  but  little  attended  to ;  and  the 
neglect  of  it  has,  I  believe,  arisen  in  a  great  measure,  from  the 
opinion  which  has  generally  prevailed  in  this  country,  that  the 
beneficial  effects  of  climate  are  evinced  chiefly  in  consumptive  dis- 
eases. Such  an  opinion  could  have  originated  only  in  a  very 
limited  acquaintance  with  the  influence  of  climate  on  disease ;  and 
is,  indeed,  so  far  from  being  a  correct  view  of  the  matter,  that,  were 
the  character  of  this  remedy  to  be  estimated  by  its  effects  on  con- 
sumption, it  would  be  justly  valued  at  a  very  low  rate.  In  dys- 
pepsia, and  disorders  of  the  digestive  organs  generally,  and  in  the 
nervous  affections  and  distressing  mental  feelings  which  so  often 
accompany  these;  in  asthma,  in  bronchial  diseases,  in  scrofula, 
and  in  rheumatism,  the  beneficial  effects  of  climate  are  far  more 
strongly  evinced  than  they  are  in  consumption.  In  cases  also  of 
general  delicacy  of  constitution  and  derangement  of  the  system  in 
childhood  and  in  youth,  which  cannot  be  strictly  classed  under  any 
of  these  diseases ;  and  in  that  disordered  state  of  the  general  health 
which  so  often  occurs  at  a  certain  period  of  more  advanced  life, 
climacteric  disease,  in  which  the  powers  of  the  constitution,  both 
mental  and  bodily,  fail,  and  the  system  lapses  into  a  state  of  prema- 
ture decay,  change  of  climate  becomes  a  valuable  remedial  agent. 

The  undue  confidence  in  the  powers  of  climate  as  a  remedy  in 
consumption,  which  has  so  long  prevailed  in  this  country,  is  now 
in  danger  of  giving  place  to  the  opposite  and  equally  erroneous  ex- 
treme of  total  distrust.  This  is,  chiefly,  in  consequence  of  the  sta- 
tistical reports  on  the  health  of  our  troops  in  almost  all  quarters  of 
the  globe,  showing  that  there  is  no  immunity  from  this  disease  in 
any  climate.1 

It  is  to  be  remarked,  however,  that,  when  an  invalid  is  sent 
abroad  for  his  health,  he  goes,  by  the  direction  of  his  physician,  to 
the  climate  best  suited  to  his  particular  case,  and  at  the  most  favour- 

1  These  reports,  which  have  been  so  admirably  drawn  up  by  Mr.  Mar- 
shall, Deputy  Inspector-General  of  Hospitals,  Major  Tulloch,  and  Dr.  Bal- 
four,  are  invaluable,  and  do  infinite  credit  to  the  judgment  and  discrimina- 
tion of  Lord  Howick,  late  Secretary  at  War,  who  first  duly  appreciated  their 
importance  to  medical  science,  and  to  Sir  James  M'Grigor,  who,  with  the 
able  assistance  of  Dr.  Theodore  Gordon,  planned  the  annual  reports  and 
topographical  statements  on  which  the  Statistical  Reports  are  founded. 
These  annual  reports,  which  are  highly  creditable  to  the  medical  officers  of 
the  army,  were  first  projected  by  Sir  James  M'Grigor,  on  his  being  placed 
at  the  head  of  the  medical  department  in  1815,  and  have  been  kept  up  on  an 
uniform  plan  since  1816. 


14  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

able  season  of  the  year.  Moreover,  he  goes  prepared  to  avail  him- 
self of  all  the  advantages  of  his  new  situation,  and  to  avoid,  as  far 
as  possible,  its  disadvantages.  Hence,  the  influence  of  any  climate 
upon  such  an  invalid,  must  be  estimated  very  differently  from  the 
influence  of  the  same  climate  on  the  permanent  inhabitants,  or  on 
our  troops  who  are  resident  in  it  at  all  seasons,  and  are  exposed  to 
all  its  prejudicial  influences  for  years,  as  well  as  to  many  other 
causes  calculated  to  injure  health. 

The  great  lesson  which  the  Army  Medical  Reports  teach,  in  re- 
gard to  consumption,  is  this:  that,  as  it  is  a  prevalent  and  fatal 
disease  in  all  climates,  and  among  all  nations,  our  attention  should 
be  chiefly  directed,  not  to  a  state  of  disease  which  is  incurable  by 
climate  or  any  other  means,  but  to  the  prevention  and  cure  of  the 
disordered  state  of  health,  which  constitutes  the  real  cause  of  con- 
sumption. It  cannot  be  too  strongly  impressed  upon  the  public, 
that  until  pulmonary  consumption  is  viewed  as  a  secondary  dis- 
ease, originating  in  a  morbid  state  of  the  whole  system,  we  shall 
make  little  progress  in  diminishing  the  rate  of  mortality  from  it,  or 
improving  the  public  health. 

I  have  thought  it  right  to  make  these  remarks  to  show  that  I 
have  not  overlooked  the  result  of  the  observations  of  the  army 
medical  officers.  They  contain  much  valuable  matter  on  the 
geography  of  disease,  and  on  the  causes  of  sickness  and  mortality 
among  our  troops  in  different  climates  ;  and  there  can  be  no  doubt 
they  will  lead  to  the  adoption  of  measures  for  preserving  and  im- 
proving the  health  of  the  army.  But  as  regards  the  influence  of 
change  of  climate  in  the  prevention  and  even  cure  of  disease,  the 
information  contained  in  these  reports  does  not  diminish  our  hopes 
of  benefit  from  a  temporary  change  of  climate,  or  even  from  a  more 
permanent  residence,  when  the  climate  suited  to  the  individual 
case  is  selected,  and  all  other  necessary  precautions  adopted.  When 
change  of  climate  is  judiciously  employed  as  a  remedy  for  the  con- 
stitutional disorder  which  precedes  consumption,  there  will  no 
longer  remain  any  doubts  of  its  beneficial  influence  ;  and  what  a 
siygle  change  of  climate  does  not  effect,  a  succession  of  such 
changes  will  often  be  found  to  accomplish. 

Traveling. — The  mere  act  of  traveling  over  a  considerable 
extent  of  country  is  itself  a  remedy  of  great  value3  and,  when  judi- 
ciously conducted,  will  materially  assist  the  beneficial  action  of  cli- 
mate. A  journey  may  indeed  be  regarded  as  a  continuous  change 
of  climate,  as  well  as  of  scene  ;  and  constitutes  a  remedy  of  une- 
qualed  power  in  some  of  those  morbid  states  of  the  system  in  which 
the  mind  suffers  as  well  as  the  body.  In  chronic  irritation  and 
passive  congestion  of  the  mucous  surfaces  of  the  pulmonary  and 
digestive  organs,  especially  when  complicated  with  a  morbidly 
sensitive  state  of  the  nervous  system,  traveling  will  often  effect 
more  than  any  other  remedy  with  which  we  are  acquainted. 

But  neither  traveling  nor  climate,  nor  their  combined  influence, 
will  produce  much  permanent  benefit,  unless  directed  with  due 


INTRODUCTION.  15 

regard  to  the  nature  of  the  case,  and  aided  by  proper  regimen. 
And  here  I  would  comment  upon  the  error  of  expecting  too  much 
from  the  mere  change  of  climate : — The  air,  or  climate,  is  often 
regarded  by  patients  as  possessing  some  specific  quality,  by  virtue 
of  which  it  directly  cures  the  disease.  This  erroneous  view  of  the 
matter  not  unfrequently  proves  the  bane  of  the  invalid,  by  leading 
him,  in  the  fulness  of  his  confidence  in  climate,  to  neglect  other 
circumstances,  an  attention  to  which  may  be  more  essential  to  his 
recovery  than  that  in  which  all  his  hopes  are  centred. 

A  residence  in  a  mild  climate  will,  no  doubt,  often  do  much. 
Among  other  advantages,  for  example,  it  will  enable  the  invalid  to 
be  much  in  the  open  air  during  a  part  of  the  year  when,  were  he 
in  this  country,  he  would  be  either  confined  to  the  house,  or  ex- 
posed to  an  atmosphere  more  likely  to  increase  than  mitigate  his 
complaints.  The  exercise  enjoyed  in  a  temperate  atmosphere, 
while  it  improves  the  general  health,  relieves  the  affected  organs, 
by  promoting  and  maintaining  a  more  free  and  equable  circulation 
in  the  surface  and  extremities  ;  and  the  constitution  thus  improved, 
may  be  enabled  to  overcome  a  disease  under  which  it  might  have 
sunk  in  less  favourable  circumstances.  The  new  scenes  and  the 
objects  of  interest,  with  which  the  South  of  Europe,  more  espe- 
cially Italy,  abounds,  exert  a  direct  and  beneficial  influence  also  on 
the  mental  constitution  ;  and  this  influence  will,  in  many  cases,  be 
greatly  assisted,  in  an  indirect  manner,  by  the  necessary  abstrac- 
tion of  the  invalid  from  many  causes  of  care  and  anxiety — in  other 
words,  from  many  sources  of  disease,  to  which  he  would  have  been 
exposed  at  home. 

These  are  some  of  the  more  obvious  advantages  which  the  in- 
valid may  expect  to  derive  from  a  residence  in  a  foreign  climate; 
and  they  are  assuredly  great :  but  if  he  would  reap  the  full  mea- 
sure of  good  which  his  new  position  places  within  his  reach,  he 
must  trust  more  to  himself  and  to  his  own  conduct,  than  to  the 
simple  influence  of  any  climate,  however  genial  :  he  must  adhere 
strictly  to  such  a  mode  of  living  as  his  case  requires  ;  he  must  avail 
himself  of  all  the  advantages"  which  the  climate  possesses,  and 
eschew  those  disadvantages  from  which  no  climate  or  situation  is 
exempt ;  moreover,  he  must  exercise  both  resolution  and  patience 
in  prosecuting  all  this  to  a  successful  issue. 

In  the  body  of  the  work,  I  shall  have  many  opportunities  of 
pointing  out  how  the  various  circumstances,  connected  with  change 
of  climate,  operate  in  the  renovation  of  constitutions  broken  down 
by  the  long  continuance  of  chronic  diseases.  At  present  I  wish 
rather  to  impress  the  mind  of  the  invalid  with  the  danger  of  trust- 
ing too  much  to  climate.  Here,  as  in  every  other  department  of 
the  healing-  art,  we  must  be  guided  by  experience ;  and  must  rest 
satisfied  with  the  amount  of  power  which  the  remedy  concedes  to 
us.  The  charlatan  may  boast  of  a  specific  for  many  or  for  all  dis- 
eases ;  the  man  of  science  knows  that  there  exists  scarcely  a  single 
remedy  for  any  disease  which  can  warrant  such  a  boast ;  and  that 


16  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

it  is  only  by  acting  on,  and  through  the  numerous  and  compli- 
cated functions  of  the  living  body,  in  various  ways  and  by  various 
means,  and  by  carefully  adapting  our  agents  to  the  circumstances 
of  each  individual  case,  that  we  can  check  or  remove  the  disorders 
of  the  animal  system,  more  especially  those  which  have  long  ex- 
isted. Let  it  not  then  be  imagined  that  change  of  climate,  how- 
ever powerful  as  a  remedy,  can  be  considered  as  at  all  peculiar  in 
its  mode  of  action,  or  as  justifying,  on  the  part  either  of  the  physi- 
cian or  patient,  the  neglect  of  those  precautions  which  are  requi- 
site to  ensure  the  proper  action  of  other  remedies.  Had  I  not 
considered  climate  a  remedial  agent  of  great  value,  and  deserving 
the  utmost  attention  of  medical  men,  the  present  work  would  not 
have  been  undertaken ;  but  I  should  feel  that  I  were  at  once  com- 
promising the  dignity  and  honour  of  my  profession,  and  acting  in 
direct  opposition  to  the  dictates  of  experience,  if  I  admitted  for  a 
moment,  that  it  is  one  possessing  specific  powers,  or  which  may  be 
indiscriminately  employed,  without  regard  to  the  general  and  fun- 
damental principles  of  medical  science. 

The  importance  which  I  attach  to  these  considerations,  and  the 
conviction  that  they  are  not  sufficiently  attended  to  in  the  applica- 
tion of  climate  as  a  remedial  agent,  has  induced  me  to  reverse  the 
order  of  my  subject  in  the  present  edition,  and  to  notice  the  dis- 
eases benefited  by  change  of  climate,  before  describing  the  different 
climates  themselves. 


PART    THE    FIRST. 


ON  DISEASES. 


DISORDERS  OF  THE  DIGESTIVE  ORGANS. 

The  prevalence  of  disorders  of  the  digestive  organs  and  the  great 
influence  which  they  exercise  over  the  other  diseases  treated  of  in 
this  volume,  claim  for  them  the  first  consideration.  On  the  present 
occasion,  however,  I  do  not  think  it  necessary  to  enter  so  fully  into 
the  subject  as  in  the  former  editions  of  this  work,  seeing  that  it  has 
been  more  attended  to  of  late  years.  I  shall  therefore  limit  myself 
to  the  description  of  those  features  of  dyspeptic  disorder  by  which 
the  selection  of  the  climate  adapted  to  each  of  its  forms  requires  to 
be  regulated. 

For  my  present  purpose  the  morbid  states  of  the  digestive  organs 
may  be  classed  under  three  heads  :  —  Inflammatory,  or  gastritic 
dyspepsia  ;  Irritable,  or  nervous  dyspepsia  ;  and  atonic  dys- 
pepsia, or  that  form  of  the  complaint  which  depends  chiefly  on  a 
loss  of  tone. 

Although  there  are  symptoms  common  to  these  different  forms 
of  dyspepsia,  there  are  others  peculiar  to  each,  and  by  which  they 
are  characterised. 

In  the  gastritic,  or  inflammatory  species,  the  tongue  is  redder 
than  natural,  especially  towards  the  apex,  where  it  is  beset  with 
small  elevated  points  of  a  still  brighter  colour.  It  is  also,  for  the 
most  part,  furred  towards  the  base.  In  the  morning  on  first  awak- 
ing, it  is  dry,  more  particularly  in  cases  where  the  irritation  ex- 
tends to  the  duodenum  and  liver.  The  gums  are  red.  swollen,  and 
spongy,  and  bleed  easily  ;  the  mucous  membrane  of  the  throat  is 
red,  often  dry  and  shining,  and  aphthous  ulcers  are  apt  to  form  on 
the  tongue  and  inner  surface  of  the  month.  The  appetite  is  good, 
often  craving.  There  is  a  disposition  to  thirst  ;  and  pressure  over 
the  stomach  generally  gives  uneasiness.  The  urine  is  high  co- 
loured or  turbid;  the  skin  dry  and  sometimes  affected  with  erup- 
tions, and  the  extremities,  although  occasionally  cold,  are  often 
hot  and  dry,  especially  in  the  night  ;  whilst  perspirations  are  not 
unfrequent  towards  morning. 

The  eyes  are  injected,  and  the  eyelids  red  and  swollen.  The 
pulse  is  contracted  and  quickened,  more  especially  after  meals,  and 
1—  b  2  dark 


18  CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

towards  night,  except  in  languid  constitutions,  in  which  it  remains 
slow.  There  is  frequently  a  disposition  to  sleep  during  the  day. 
and  at  night  the  sleep  is  uncertain  ;  the  Dearly  part  of  the  night 
being  often  passed  in  watchfulness,  whilst  in  the  morning  there  is  a 
heavy  slumber,  followed  on  awaking  by  oppression  and  weariness, 
in  place  of  the  refreshment  which  succeeds  to  natural  rest.  Head- 
ach  is  not  an  uncommon  symptom  ;  the  pain  is  generally  seated  in 
the  forehead,  and  the  sensation  is  that  of  tightness  and  oppression 
rather  than  acute  pain.  It  is  most  common  in  the  evening  and 
during  digestion  ;  and  that  more  certainly  after  an  exciting  meal. 
The  patient  is  apt  to  be  irritable,  querulous,  and  despondent;  and 
there  is  little  inclination  to  mental  exertion,  or  power  in  concen- 
trating the  mind  on  any  subject.  The  influence  of  an  irritated 
state  of  the  digestive  organs  over  the  mental  as  well  as  bodily 
powers,  I  may  remark  in  passing,  is  far  greater  than  is  generally 
believed.  In  childhood,  the  irritability  of  temper  with  which  it  is 
accompanied  is  very  remarkable  ;  when  the  disorder  is  protracted, 
it  is  also  a  frequent  cause  of  dulness  in  children,  rendering  them 
incapable  of  mental  application.  At  a  later  period  of  life,  the  dis- 
position is  often  so  thoroughly  changed,  the  mind  rendered  so  in- 
capable of  exertion,  and  the  memory  so  much  impaired  by  long 
continued  irritation  of  the  digestive  organs,  that  the  sufferer 
becomes  unable  to  apply  himself  steadily  to  any  thing,  and  is  inca- 
pacitated for  his  usual  avocations,  or  even  the  ordinary  intercourse 
of  social  life. 

Atonic  dyspepsia. — In  atonic  dyspepsia  the  symptoms  indicate 
a  loss  of  tone  in  the  digestive  organs.  There  is  little  or  no  appe- 
tite, often  a  loathing  of  food,  and  even  sometimes  nausea.  After 
eating  there  is  a  sense  of  distention  or  of  oppression  in  the  stomach, 
accompanied  by  a  feeling  of  general  uneasiness  or  listlessness,  and 
a  disposition  to  chilliness  ;  some  time  after  the  meal  there  are  eruc- 
tations, heartburn,  and  other  symptoms  of  laborious  digestion.  The 
tongue  is  pale  and  flaccid,  not  much  furred,  and  seldom  or  never 
dry.  There  is  not  much  thirst  except  during  digestion.  The 
urine  is  pale  and  abundant,  and  the  bowels  constipated.  The  pulse 
is  weaker  and  sometimes  slower  than  natural.  The  surface  and 
extremities  easily  become  cold ;  the  countenance  is  pale  and  the 
expression  dull  and  heavy ;  there  are  inaptitude  and  inability  for 
bodily  exertion,  and  a  corresponding  languor  of  mind. 

These  symptoms  vary  in  intensity  at  different  times.  In  bright 
dry  weather,  or  under  circumstances  of  pleasurable  mental  emotion, 
the  appetite  is  better  and  the  digestion  is  performed  without  the 
usual  feeling  of  distress.  On  the  other  hand,  in  damp,  cloudy 
weather,  or  under  feelings  of  mental  depression,  all  the  symptoms 
are  greatly  aggravated  and  others  superadded.  Epigastric  pain, 
great  distention,  fetid  eructations,  vomiting,  headach,  vertigo,  faint- 
ness,  cold  clammy  perspirations  and  cramps  are  liable  to  supervene, 
if  much  food,  or  food  of  an  indigestible  quality,  has  been  eaten.  In 
such  a  state  of  stomach,  fainthess,  amounting  to  syncope,  may 


DISORDERS  OF  THE  DIGESTIVE  ORGANS.  19 

occur  after  a  heavy  or  indigestible  meal,  more  especially  after  long 
fasting. 

This  form  of  dyspepsia  occurs  most  frequently  in  languid  leuco- 
phlegmatic  temperaments,  and  in  cold  humid  weather  and  situa- 
tions. 

Nervous  dyspepsia. — In  nervous  or  irritable  dyspepsia,  the 
tongue  deviates  less  from  the  natural  state ;  it  is  pale,  and  often 
covered  with  a  thin  white  fur ;  in  some  cases  it  is  swollen,  and 
exhibits  the  impressions  of  the  teeth  along  its  margins,  especially 
in  the  morning ;  it  is  rarely  dry,  and  there  is  little  thirst.  The 
appetite  is  unsteady,  sometimes  craving,  and  at  other  times  quite 
wanting,  especially  for  breakfast.  Flatulency  is  a  prominent  symp- 
tom. The  urine  is  pale  and  often  very  copious ;  the  bowels, 
though  constipated  in  some  cases,  are  more  frequently  in  an  oppo- 
site state,  and  this  is  especially  the  case  when  the  nervous  system 
is  peculiarly  sensitive. 

The  sleep  is  uncertain,  easily  interrupted,  and  often  unrefresh- 
ing.  The  pulse  is  small  and  quick,  but  less  steady  in  its  character 
than  in  gastritic  or  in  atonic  dyspepsia.  The  skin  is  cool,  and  often 
damp  and  clammy.  Headach  is  a  prominent  and  often  very  dis- 
tressing symptom  in  this  form  of  dyspepsia.  The  morning  is  the 
most  frequent  period  of  its  attack,  being  felt  on  awaking ;  and  at 
all  times  it  is  more  liable  to  occur  when  the  stomach  is  empty  than 
during  the  process  of  digestion:  hence  long  fasting  proves  a  fre- 
quent exciting  cause  ;  over  fatigue,  articles  of  food  which  irritate 
rather  than  excite  the  stomach,  such  as  sweet  subacid  substances, 
pastry,  dry  fruits,  and  imperfectly  masticated  food  ;  strong  mental 
impressions,  and  the  air  of  crowded  rooms,  are  also  frequent  ex- 
citing causes.  The  headach,  when  occurring  during  the  day,  is 
sometimes  sudden,  but  in  the  severer  attacks  is  generally  preceded 
by  a  sense  of  coldness  and  creeping  on  the  surface,  which  may 
amount  to  shivering.  In  some  cases  the  attack  is  preceded  by 
numbness  in  the  extremities,  by  dimness  of  sight,  or  ocular  spectra  ; 
in  others,  a  peculiar  uneasy  sensation,  originating  in  one  of  the  ex- 
tremities, ascends  gradually  to  the  head,  resembling  the  aura  epi- 
leptica.  Nausea  or  vomiting  occasionally  occurs  at  this  stage,  and 
the  pulse  is  mostly  slower  than  natural.  In  the  commencement, 
there  is  a  sensation  of  uneasiness  rather  than  of  actual  pain ;  but 
as  the  feeling  of  coldness  diminishes,  the  true  headach  becomes 
developed.  The  pain  is  then  intense  and  throbbing,  affecting  one 
side  in  general  more  than  the  other  ;  and  in  the  cases  in  which  it 
has  been  of  the  most  agonising  kind  has  been  confined  to  a  small 
spot  over  one  eyebrow  or  temple.  The  upper  and  back  part  of  the 
head  is  often  the  seat  of  pain,  and  the  latter  place  is  particularly  apt 
lo  be  so,  when  the  headach  is  partly  dependent  on  uterine  irrita- 
tion or  congestion.  The  pain,  wherever  seated,  is  greatly  aggra- 
vated by  mental  excitement  or  bodily  exertion.  This  class  of 
headachs  is  common,  in  delicate  nervous  persons,  particularly 
females,  when  its  immediate  dependence  on  dyspepsia  is  often 

2* 


20  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

overlooked,  but  very  generally  the  connection  is  discovered  upon 
minute  inquiry  into  the  circumstances  of  the  case. 

The  temper  is  apt  to  be  fretful,  and  the  mind  anxious  and  de- 
sponding, particularly  regarding  the  health. 

Independently  of  the  particular  symptoms  belonging  to  each 
form  of  dyspepsia,  there  are  circumstances  in  their  general  cha- 
racter which  distinguish  them.  The  symptoms  which  accompany 
gastritic  dyspepsia,  are  more  fixed  and  permanent ;  they  may  be 
present  in  a  greater  or  less  degree,  according  to  circumstances,  but 
they  are  scarcely  ever  absent.  In  nervous  dyspepsia,  on  the  con- 
trary, the  symptoms  vary  in  a  remarkable  manner.  The  patient 
feels,  at  times,  almost  entirely  free  from  them,  and  the  functions  of 
the  digestive  organs  are  performed  with  scarcely  any  indication  of 
derangement ;  at  other  times  all  the  symptoms  are  greatly  aug- 
mented, the  patient  being  unable  to  assign  any  cause  for  their  dis- 
appearance, in  the  one  case,  or  their  increase  in  the  other.  Atonic 
dyspepsia  resembles  more  in  its  characters  the  nervous  dyspepsia 
with  which  it  is  often  complicated.  Both  forms  are  greatly  influ- 
enced by  mental  emotions,  changes  of  the  weather,  and  other 
causes  which  particularly  affect  the  nervous  system.  The  symp- 
toms which  characterise  the  gastritic  form  of  the  disease,  are  in- 
creased by  stimulants  of  every  kind  taken  into  the  stomach,  whereas 
the  same  means  often  afford  temporary  relief  in  the  other  two 
forms. 

In  mixed  cases,  these  distinguishing  characters  may  be  observed 
more  or  less  as  the  one  or  other  form  of  dyspepsia  prevails.  When 
the  gastritic  and  nervous  dyspepsia  exist  together  we  have  both 
inflammatory  excitement  and  extreme  morbid  sensibility — the  one 
or  other  state  predominating  at  different  times.  This  form  of  the 
disease  occurs  chiefly  in  persons  of  a  nervous  temperament,  to 
whom  the  causes  of  gastritic  dyspepsia  have  been  applied.  In  like 
manner,  nervous  is  often  associated  with  atonic  dyspepsia  ; — a  mor- 
bidly sensitive  state  of  the  stomach  with  loss  of  tone,  a  condition 
the  converse  of  inflammation.  Yet,  in  all  these  mixed  cases,  the 
distinctive  characters  of  the  prevailing  affection  may  generally  be 
recognised. 

But  in  protracted  cases  the  disorder  is  seldom  confined  to  the 
stomach;  it  is  gradually  propagated  to  other  portions  of  the  diges- 
tive tube,  and  the  secreting  organs  in  connection  with  it ;  more 
especially  to  the  duodenum  and  liver.  In  many  cases,  indeed,  the 
disease  is  chiefly  seated  in  the  duodenum,  constituting  what  has 
been  denominated  duodenal  dyspepsia,  a  very  important  form  of 
dyspeptic  complaint,  to  which  I  shall  have  occasion  to  recur,  when 
noticing  the  diseases  of  children,  under  the  head  of  strumous  or 
scrofulous  dyspepsia,  or  that  form  which  is  most  frequently  ob- 
served in  children  of  a  scrofulous  constitution. 

We  also  find  that  the  morbid  state  of  the  digestive  organs,  in 
place  of  being  propagated  along  the  mucous  surfaces,  extends  its 
influence  to  other  systems.  Thus  we  find  it  giving  rise  to  various 


DISORDERS  OF  THE  DIGESTIVE  ORGANS.  21 

affections  of  the  skin,  of  the  joints,  and  of  the  nervous  system. 
Among  the  last  may  be  mentioned,  in  addition  to  headachs,  con- 
vulsive affections,  tic  douloureux,  paralysis,  amaurosis,  deafness, 
loss  of  smell,  loss  of  voice,  spasmodic  cough,  asthma,  palpitation,  &c. 

The  nature  of  the  secondary  affection  depends,  often,  upon  pecu- 
liarities of  constitution  ;  but  frequently,  also,  upon  accidental 
causes,  exciting  or  disposing  to  particular  diseases  during  the  ex- 
istence of  dyspepsia.  The  new  disease  being  engrafted  on  the  old, 
becomes  as  it  were  dependent  on  it,  and  the  former  cannot  be  cured 
till  the  latter  is  removed.  The  secondary  disease  being  established, 
the  primary  affection  is  often  mitigated,  at  least  for  a  time.  Indeed, 
so  remarkably  is  this  the  case,  that  the  primary  disease  is  frequently 
overlooked,  both  by  the  patient  and  his  medical  attendant,  amid  the 
more  prominent  symptoms  of  the  secondary  affection.  This  I 
found  frequently  the  case  in  patients  sent  abroad  labouring  under 
chronic  bronchial  and  tracheal  irritation,  symptomatic  of  gastritic 
and  duodenal  dyspepsia. 

Among  the  remedial  measures  for  these  various  morbid  condi- 
tions of  the  digestive  organs,  and  the  sympathetic  diseases  which 
originate  in  them,  change  of  climate  is  one  of  the  most  efficient. 
Even  when  the  patient  cannot  avail  himself  of  a  more  complete 
change  of  climate,  he  may  still  derive  much  benefit  from  a  tempo- 
rary residence  in  some  of  the  milder  situations  in  our  own  island. 

In  recommending  such  a  change,  however,  to  the  dyspeptic  in- 
valid, the  peculiar  disorder  of  the  stomach  must  be  attended  to. 
The  different  forms  of  the  disease,  noticed  above,  require  different 
climates.  The  patient  with  gastritic  dyspepsia  should  not,  for  ex- 
ample, go  to  Nice,  nor  the  southeast  of  France.  In  cases  of  this 
kind,  the  southwest  of  France  or  Devonshire  are  preferable,  and 
Rome  and  Pisa  are  the  best  places  in  Italy.  On  the  other  hand,  in 
atonic  dyspepsia,  in  which  languor  and  sluggishness  of  the  system, 
as  well  as  of  the  digestive  organs,  prevail,  with  lowness  of  spirits 
and  hypochondriasis,  Nice  is  to  be  preferred  to  all  the  other  places 
mentioned  ;  and  Naples  will  generally  agree  better  than  Rome  or 
Pisa ;  while  the  southwest  of  France  and  Devonshire,  and  all 
similar  climates,  would  be  injurious.  In  the  nervous  form  of  dys- 
pepsia a  climate  of  a  medium  character  is  the  best,  and  the  choice 
should  be  regulated  according  as  there  is  a  disposition  to  the  gas- 
tritic or  the  atonic  form. 

In  the  more  complicated  and  protracted  cases,  still  more  dis- 
crimination is  required  in  selecting  the  best  climate  and  residence  ; 
as  we  must  take  into  consideration  not  merely  the  character  of  the 
primary  disorder,  and  the  state  of  mind  with  which  it  is  associated, 
but  the  nature  of  the  secondary  affection  which  may  already  exist, 
or  to  which  the  patient  may  be  predisposed. 

To  insure  the  full  advantages  to  be  derived  from  the  best  se- 
lected climate,  urgent  symptoms  should  be  removed  or  alleviated 
before  the  patient  commences  his  journey  ;  and  he  should,  more- 
over, have  the  nature  of  his  disorder,  and  the  principles  upon  which 


22  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

he  should  regulate  himself  while  traveling,  and  during  his  residence 
abroad,  fully  explained  to  him.  Indeed,  the  want  of  attention  to 
these  things  is  one  of  the  chief  reasons  why  so  many  dyspeptic  in- 
valids derive  little  permanent  advantage  from  their  summer  tour, 
or  even  from  a  more  prolonged  residence  abroad.  In  order  to  secure 
success  from  change  of  air  or  climate,  it  is  necessary  that  the  pa- 
tient should  understand  the  conditions  on  which  the  promise  of 
advantage  is  made,  and  how  they  are  to  be  best  and  most  perfectly 
fulfilled.  Above  all,  it  should  be  impressed  on  his  mind,  that  he  is 
not  to  expect  too  much  from  climate  ;  that  he  must  sedulously 
avoid  the  causes  which  brought  on  the  disease,  and  adhere  with 
steadiness  to  such  a  general  regimen  as  is  necessary  for  its  removal. 
Aided  by  this  moral  and  medical  discipline,  a  winter  spent  in  a 
favourable  climate  cannot  fail  to  prove  highly  beneficial  to  the  dys- 
peptic invalid  ;  and  a  well  directed  course  of  mineral  waters,  the 
following  summer,  will,  in  many  cases;  be  of  the  greatest  service  in 
restoring  the  impeded  functions  of  the  abdominal  viscera  and  of  the 
skin.  After  this,  the  patient  may  enjoy  a  degree  of  bodily  health, 
and  of  mental  energy,  to  which  he  has  long  been  a  stranger ;  and 
may  continue  to  reap  the  fruits  of  his  perseverance  and  self-denial, 
so  long  as  he  shall  avoid  the  exciting  causes  of  the  disease. 

The  extent  to  which  change  of  air  or  climate  requires  to  be  car- 
ried, for  the  removal  of  stomach  complaints,  will  depend  on  the 
circumstances  of  the  case.  In  many  instances  a  few  months,  even 
a  few  weeks,  judiciously  employed,  will  do  much  for  the  restoration 
of  the  health;  in  others,  a  much  longer  period  will  be  required. 
In  treating,  therefore,  of  the  influence  of  change  of  climate  and 
change  of  air  in  dyspeptic  disorders,  it  will  be  both  convenient  and 
useful  to  divide  them  into  two  classes — the  more  recent  and  simple, 
and  the  more  protracted  and  complicated  cases. 

Of  the  more  recent  and  simple  cases  of  Dyspepsia. — Under 
this  class  of  dyspeptic  patients  is  comprehended  that  numerous 
body  of  our  citizens,  and  the  inhabitants  of  large  towns  generally, 
whose  health,  and  digestive  organs  in  particular,  have  suffered  by 
a  sedentary  life,  close  application  to  business,  errors  in  regimeri,&c. 
during  the  winter,  and  who  require  change  of  air  during  the 
summer. 

The  plans  generally  adopted  with  this  view,  are  a  visit  to  some 
of  our  watering  places,  or  a  tour  through  the  mountainous  parts  of 
our  own  island,  or  on  the  Continent, — and  more  particularly  in 
Switzerland.  The  preference  which  one  or  the  other  of  these  mea- 
sures may  deserve,  will  depend  upon  the  nature  of  the  case,  the 
convenience  of  the  patient,  and  various  other  circumstances,  which 
can  be  appreciated  only  by  the  patient  himself,  and  his  physician. 

We  shall  suppose  that  a  tour  is  the  measure  adopted.  Having 
had  the  more  urgent  symptoms  of  his  complaint  removed  or  alle- 
viated, before  he  sets  out,1  the  next  object  of  importance  with  the 

1  See  Introductory  Remarks  to  PART  SECOND. 


DISORDERS  OP  THE  DIGESTIVE  ORGANS.  23 

dyspeptic  traveller  is  diet.  This  must  be  regulated  according  to 
the  state  of  the  digestive  organs,  regard  being  had  to  the  exciting 
effects  of  traveling,  which  render  more  especial  attention  to  the  diet 
necessary  during  a  journey.  If  much  gastric  irritation  exists,  and, 
more  espicially,lf  this  is  accompanied  with  any  disposition  to  fever, 
the  diet  should  be  very  mild  and  moderate  in  quantity.  A  small 
proportion  of  animal  food,  once  a-day,  is  all  that  should  be  allowed 
in  such  cases.  Tea  or  arrow-root,  or  sago,  forms  the  best  evening 
meal.  The  best  general  drink  is  toast-water;  wine,  and  all  kinds 
of  fermented  liquors  and  spirits,  should  be  avoided  by  the  greater 
number  of  dyspeptic  patients  during  a  journey. 

I  am  aware  that  in  traveling  on  the  Continent,  it  is  not  always 
an  easy  matter  to  obtain  that  kind  of  food  which  is  suitable  to 
irritable  or  delicate  stomachs ;  but  a  little  management  on  the  part 
of  the  traveller  will  generally  suffice  to  obviate  this  difficulty.  The 
soups  of  the  Continent,  if  not  so  strong,  are  generally  more  whole- 
some, and  agree  better  with  irritable  stomachs  than  the  rich  exciting 
soups  used  in  this  country.  The  opinions  commonly  entertained 
respecting  soup  in  dyspeptic  affections,  are  not  applicable  to  every 
form  of  dyspepsia,  nor  to  all  soups. 

Fruit  should  generally  be  abstained  from,  as  it  will  seldom  be 
found  to  agree  in  any  form  of  stomach  complaint.  An  exception  is 
to  be  made  in  favour  of  good  ripe  grapes,  which  are  often  useful  in 
gastritic  dyspepsia.  Ripe  grapes,  eaten  in  considerable  quantity  for 
several  weeks  together,  is  a  remedy  (cure  de  raisins?)  employed  on 
the  Continent  in  several  complaints.  In  the  inflammatory  form  of 
dyspepsia,  more  especially  when  there  exists  a  similar  state  of  the 
mucous  membrane  of  the  intestines,  with  a  disposition  to  diarrhoea; 
also  in  chronic  cases  of  this  disease,  and  in  hemorrhoidal  affec- 
tions, ripe  grapes  are  considered  of  great  use. 

If  the  dyspeptic  invalid  will  observe  the  effects  which  the  differ- 
ent articles  of  food  produce,  and  be  true  to  himself  and  candid  in 
his  observations,  he  will  soon  discover  that  the  more  moderately  he 
lives  the  better  he  will  feel.  When  he  has  passed  a  restless  night, 
or  has  a  dry  or  loaded  tongue,  or  bitter  taste  in  the  morning,  he 
may  be  assured,  that,  the  regimen  of  the  preceding  day  was  not 
suited  to  him,  that  he  has  erred  either  in  the  quantity  or  quality  of 
his  food,  and  should  regulate  himself  accordingly  for  the  future. 

The  next  circumstance  requiring  the  particular  attention  of  the 
dyspeptic  traveller,  is  the  state  of  the  bowels.  Constipation  is  an 
evil  from  which  travellers  generally,  and  more  especially  dyspeptics, 
suffer ;  and  it  is  of  great  consequence  that  this  state  should  be  ob- 
viated. The  mild  diet  which  has  been  recommended  will  be  a 
means  of  favouring  the  action  of  the  bowels,  and  of  moderating  the 
injurious  effects  of  their  inaction  when  this  occurs.  For  the  removal 
of  constipation,  the  milder  laxatives  are  much  safer,  and  more  effec- 
tual than  drastic  purgatives.  The  latter,  even  when  given  in  the 
smallest  doses,  irritate  the  stomach  and  bowels,  and,  in  this  way, 
are  often  productive  of  more  mischief  than  the  state  they  are  in- 


24  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

tended  to  obviate,  which  state  their  frequent  repetition  tends,  more- 
over, to  confirm.  Castor  oil,  or  confection  of  senna,  or  manna, 
taken  in  such  doses  only  as  are  sufficient  to  obviate  constipation, 
are  the  best  medicines.  They  may  be  taken  at  bed-time,  so  as  to 
act  the  following  morning.  When  the  stomach  cannot  bear  these 
medicines,  a  mild  aperient  pill  may  be  occasionally  given.  But 
what  often  answers  much  better  than  any  aperient  medicine,  is  the 
use  of  mild  lavements.  To  persons  who  have  very  sensitive  bow- 
els, and  who  suffer  from  constipation,  this  proves  an  invaluable 
remedy,  more  especially  during  a  journey ;  and  no  one  should  tra- 
vel without  being  provided  with  the  means  of  relieving  the  bowels 
in  this  way.  The  relief  obtained  by  the  judicious  use  of  this 
remedy,  will  not  only  add  greatly  to  the  comfort  of  the  patient,  but 
favour  the  return  of  the  bowels  to  a  more  healthy  and  regular  per- 
formance of  their  functions;  while  it  will  obviate  the  necessity  of 
having  frequent  recourse  to  purgative  medicines,  a  fruitful  source 
of  mischief,  as  I  have  already  remarked,  to  dyspeptic  invalids.  The 
lavements  should  consist  of  water,  barley-water,  oatmeal-water,  or 
thin  gruel,  tepid,  or,  what  answers  better  in  many  cases,  an  infusion 
of  chamomile  flowers.  Cold  water  proves  very  beneficial  in  some 
cases ;  but  soap  and  more  irritating  substances  are  generally  objec- 
tionable. The  quantity  injected  need  not  be  great ;  half  a  pint,  or 
even  less,  will  often  bring  on  an  action  of  the  bowels  more  readily 
than  a  larger  quantity. 

Tepid  bathing  is  a  remedy  that  should  never  be  neglected  by  the 
dyspeptic  invalid  while  traveling.  Independently  of  its  utility  as  a 
means  of  cleanliness  and  comfort,  it  promotes  the  cutaneous  exhala- 
tion, tends  to  equalise  the  circulation,  and  cools  and  soothes  the 
whole  system. 

If  the  dyspeptic  invalid  will  attend  to  these  simple  directions,  he 
may  derive  much  and  lasting  benefit  from  his  tour.  He  should 
keep  in  mind  that  he  has  an  important  object  in  view ;  that  health 
is  only  to  be  regained  by  such  a  mode  of  traveling  as  is  compatible 
with  his  strength,  and  by  strict  adherence  to  such  a  regimen  as 
comports  with  the  deranged  state  of  his  digestive  organs. 

These  observations,  which  are  intended  chiefly  for  travellers  on 
the  Continent,  are  equally  applicable  to  those  who  confine  them- 
selves to  excursions  in  our  own  island,  or  passing  some  time  at  the 
sea-side,  or  inland  watering-places,  during  the  summer.  Those 
who  visit  the  sea-coast  will  find  the  tepid  sea-bath  a  most  valuable 
remedy.  With  a  few  dyspeptics  cold  sea-bathing  may  agree,  but 
does  not  suit  the  majority  of  cases.  The  cold  or  tepid  shower-bath 
is  better,  and  will  be  found  more  generally  beneficial.  The  warm 
or  tepid  bath  is  useful  in  almost  every  case.  The  vapour  bath  will 
prove  serviceable  in  certain  cases,  more  especially  where  the  skin 
has  been  long  in  a  dry  state ;  but  its  indiscriminate  use  for  the 
removal  of  this  symptom,  is  calculated  to  do  mischief.  It  should  be 
impressed  on  the  patient's  mind,  that  it  is  in  vain  to  expect  that  any 
kind  of  bath,  or  any  remedy,  will  restore  the  natural  secretion  of 


DISORDERS  OF  THE  DIGESTIVE  ORGANS.  25 

the  skin,  while  the  irritation  of  the  digestive  organs  is  kept  up  by 
improper  diet.  The  dry  skin  is  consequent  upon  irritation  of  some 
internal  organ ;  and  until  this  be  removed  the  natural  state  of  the 
surface  cannot  be  restored.  Without  attention  to  this,  the  vapour 
bath  will  be  of  little  use,  and  may  prove  injurious. 

The  great  and  common  errors  in  dyspeptic  cases  are,  as  I  have 
already  said,  the  condition  in  which  invalids  are  sent  abroad,  and 
the  manner  in  which  they  live  while  there.  Much  greater  and 
more  permanent  benefit  would  be  derived  from  a  change  of  air, 
were  its  effects  aided  by  such  remedial  measures  and  such  a  regi- 
men as  the  nature  of  the  case  requires.  As  these  matters  are  gene- 
rally managed,  the  invalid  has  frequently  not  returned  many 
weeks,  when  he  finds  himself  in  the  same  state  nearly  as  when  he 
left  his  home.  The  reason  of  this  is  sufficiently  obvious.  Previously 
to  the  tour,  nothing  effectual  is  done  for  the  mitigation  of  the  disor- 
der of  the  digestive  organs,  and  no  system  of  regimen  is  adopted, 
by  which  the  beneficial  effects  of  change  of  air  and  traveling  may 
be  favoured  and  rendered  more  permanent.  All  is  trusted  to  air, 
relaxation  from  business,  and  amusement ;  and  when  the  influence 
of  these  is  withdrawn,  the  dyspeptic  and  nervous  invalid  lapses 
rapidly  into  his  former  state. 

Of  the  more  protracted  and  complicated  cases  of  Dyspepsia.— 
Persons  whose  digestive  organs  have  been  long  deranged,  and 
whose  constitutions  have  suffered  in  consequence,  will  require,  in 
order  to  obtain  much  or  lasting  benefit,  a  more  prolonged  residence 
in  a  mild  climate.  The  impressions  produced  by  causes  operating 
for  a  series  of  years  on  the  digestive  organs,  and.  through  them,  on 
other  important  organs,  and  on  the  system  generally,  are  not  to  be 
effaced  by  a  residence  of  a  few  months  in  the  best  climate,  even 
when  assisted  by  the  most  judicious  regimen,  and  the  most  exem- 
plary conduct  on  the  part  of  the  patient. 

Generally  speaking,  such  invalids  will  derive  benefit  by  changing 
our  damp,  chilly  climate,  for  a  drier  and  milder  one,  during  the 
winter.  But  it  is  not  a  matter  of  indifference  in  what  place  they 
fix  their  abode ;  and,  indeed,  it  was  chiefly  the  consideration  of  this 
circumstance  which  induced  me  to  go  somewhat  into  detail,  in 
endeavouring  to  describe  the  distinguishing  characters  of  the  differ- 
ent affections  of  the  digestive  organs. 

I  have  pointed  out  three  forms  of  dyspeptic  disorders  : — one,  in 
which  there  is  an  inflammatory  state  of  the  mucous  surfaces  of  the 
digestive  canal;  another,  in  which  an  opposite  condition  prevails — 
a  state  of  atony;  and  a  third,  in  which  a  morbidly  sensitive  state  of 
these  organs  is  the  principal  feature,  and  which  is  also,  for  the  most 
part  accompanied  with  a  languid  condition  of  the  digestive  function. 
These  are  important  distinctions,  and  must  never  be  lost  sight  of  in 
prescribing  for  dyspeptic  patients,  whether  it  be  regimen  or  climate. 

It  is  true  that  these  morbid  states  pass  into  each  other  in  every 
variety  of  shade,  from  the  pure  inflammatory  dyspepsia  on  the  one 
hand  to  the  pure  atonic  dyspepsia  on  the  other ;  and  the  successful 


26  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

management  of  each  case  will  much  depend  upon  the  degree  of 
discrimination  exercised  in  referring  it  to  its  proper  place  in  the 
scale.  This  applies  as  much  to  change  of  climate,  as  to  any  other 
remedy. 

The  selection  of  a  residence  even  in  the  same  place  is  not  a  mat- 
ter of  indifference  to  very  sensitive  invalids.  One  will  feel  himself 
better  in  an  elevated  situation,  another  in  a  lower  and  more  shel- 
tered one.  The  high  and  low  and  more  confined  situations  of 
Rome  and  of  Naples,  afforded  me  many  opportunities  of  observing 
the  different  effects  of  locality  on  such  persons,  and  satisfied  me  of 
the  necessity  of  attending  to  this  circumstance,  in  selecting  a  resi- 
dence for  them.  But  dyspeptic  patients,  who  pass  the  winter  in 
Italy,  need  not  in  general  be  limited  to  one  place.  Although  the 
climate  most  suited  to  the  particular  character  of  their  complaint 
should  be  selected  as  their  head-quarters,  they  may  visit,  during  the 
season,  the  principal  cities  in  the  south  of  Italy;  and  if  this  is  done 
with  judgment,  the  successive  changes  may  prove  beneficial  to  their 
health.  Generally  speaking,  Rome  will  be  the  best  residence  in 
Italy  in  gastritic  dyspepsia,  especially  during  the  spring;  Nice  the 
best  climate  in  the  purer  cases  of  atonic  dyspepsia. 

To  all  these  patients  the  spring  proves  the  period  of  the  greatest 
excitement ;  and  they  who  are  disposed  to  the  more  acute  kind  of 
stomach  affections,  must  be  particularly  on  their  guard  against  what- 
ever excites  the  digestive  organs  at  this  season.  The  same  degree  of 
stimulus  that  is  tolerated  in  the  winter,  will  prove  injurious  to  them 
in  the  spring.  In  irritation  of  the  mucous  membranes,  whether 
of  the  digestive  or  pulmonary  organs,  I  had  every  year  occasion  to 
remark  the  increase  of  excitement  that  occurred  during  the  spring 
months  in  Italy.  At  this  season  there  are  great  and  often  rapid 
alternations  of  temperature,  which  are  extremely  exciting  to  sensi- 
tive invalids.  A  powerful  sun,  frequently  accompanied  with  a 
sharp  wind  during  the  day,  alternates  with  cold  nights.  This  may 
be  said  to  be  the  character  of  the  spring  every  where;  even  within 
the  tropics  it  prevails  in  some  degree ;  but  in  the  south  of  Europe 
it  is  particularly  so,  and  this  circumstance  renders  the  climate 
injurious  in  the  more  acute  degrees  of  gastritic  dyspepsia. 

It  is  not,  however,  as  I  have  already  observed,  for  the  acute 
forms  of  dyspepsia  that  I  recommend  a  change  of  climate — but  for 
affections  of  some  standing,  in  which  the  more  acute  stage  has 
passed  over,  and  with  it  the  highly  excitable  state  of  the  digestive 
organs.  For  these,  and  for  the  essentially  chronic  cases  of  dys- 
pepsia, a  residence  for  some  time  in  the  south  of  Europe,  under  the 
limitations  already  pointed  out  with  respect  to  season,  residence, 
regimen,  &c.,  will  be  of  the  greatest  service.  For  the  hypochon- 
driac, more  especially,  whose  mind  is  likely  to  feel  an  interest  in  the 
variety  of  scenes,  and  the  objects  of  art  which  present  themselves 
so  abundantly  in  Italy,  I  know  not  any  measure  more  likely  to 
prove  beneficial.  I  class  the  hypochondriacal  with  the  dyspeptic 
patients;  because,  without  venturing  to  affirm  that  hypochondriasis 


DISORDERS  OP  THE  DIGESTIVE  ORGANS.  27 

is  always  a  consequence  of  dyspepsia,  I  think  it  may  be  safely 
asserted  that  the  former  is  very  rarely  met  with  unaccompanied  by 
more  or  less  of  the  latter;  and,  in  a  large  proportion  of  cases,  both 
acknowledge  the  same  origin,  arid  are  cured  by  the  same  means. 

Though  patients  of  a  hypochondriacal  turn  of  mind  should  not 
be  encouraged  to  dwell  on  their  complaints,  and  attend  to  every 
trifling  sensation,  I  consider  it  essentially  wrong  to  send  them 
abroad  with  the  assurance  that  their  complaints  are  purely  imagi- 
nary.— that  nothing  is  required  but  change  of  air,  of  scene,  and 
amusement,  to  dispel  their  gloomy  thoughts  and  restore  their  health. 
That  there  may  be  cases  in  which  the  physician  can  do  little  more 
for  his  patient  than  commit  him  thus  to  the  wide  world,  I  am  not 
prepared  to  deny ;  but  I  believe  they  are  rare ;  at  least  I  did  not 
meet  with  any  such  during  a  residence  of  many  years  on  the  Con- 
tinent, where  my  intercourse  with  patients  of  this  class  was  pretty 
extensive.  On  the  contrary,  a  single  case  did  not  fall  under  my 
observation,  in  which  careful  examination  could  not  detect  a  de- 
ranged state  in  the  functions,  if  not  in  the  structure  of  some  internal 
organ ;  and  in  which  judicious  medical  treatment  would  not  have 
promoted  the  beneficial  influence  of  climate.  When  we  are  better 
acquainted  with  the  morbid  conditions  of  the  digestive  organs,  and 
with  the  extensive  influence  which  they  exert  on  the  mind,  we  shall 
have  less  frequent  occasion  to  confess  our  ignorance  of  the  patient's 
complaints,  by  attributing  them  to  nervousness,  to  low  spirits,  or 
other  imaginary  states  designated  by  the  like  unmeaning  ex- 
pressions. 

With  regard  to  the  general  management  of  these  cases  while  the 
patient  is  traveling, — the  same  directions  are  applicable  as  to  the 
more  recent  cases  of  dyspepsia,  which  have  just  been  detailed. 

As  on  the  journey,  so  during  their  residence  abroad,  the  diet  is 
the  most  important  circumstance  requiring  the  attention  of  dys- 
peptic invalids.  Seeing  that  the  stomach  is  the  organ  primarily 
and  principally  affected,  it  requires  no  argument  to  prove  that, 
unless  the  diet  be  such  as  is  suited  to  its  morbid  condition,  climate, 
or  any  other  means,  will  do  little  good.  It  is  impossible,  however, 
in  this  place,  to  do  more  than  point  out  in  a  general  way  the  kind 
of  diet  which  I  found  most  generally  suited  to  this  class  of  patients. 
I  have  already  remarked,  and  it  is  a  circumstance  deserving  the 
particular  attention  of  invalids,  that,  in  removing  to  a  warmer  cli- 
mate, the  sensibility  of  the  system  is  increased,  and  that  conse- 
quently stimulants  of  every  description  more  easily  excite.  Hence, 
the  diet  which  may  be  proper  in  England,  will  not  agree  in  Italy, 
nor  in  the  south  of  France.  This  remark  is  especially  applicable 
to  persons  suffering  from  stomach  complaints.  There  is,  no  doubt, 
a  difference  in  dyspeptic  patients,  as  well  as  others,  in  this  respect : 
but  I  invariably  found  a  mild  and  very  moderate  diet  the  most  suit- 
able for  them;  and  for  this  plain  reason. — that  whatever  may  be 
the  nature  of  the  disorder  of  the  stomach,  debility,  or,  in  other 


28  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

words,  a  diminution  in  the  powers  of  the  organ  for  the  performance 
of  its  functions,  is  an  almost  constant  accompaniment  of  the  disease. 

Wine,  when  it  is  permitted,  should  always  be  taken  in  great 
moderation ;  and  it  will  be  found  that  the  lighter  kinds,  if  not  acid, 
generally  agree  the  best.  Of  wines  imported  into  Italy,  those  of 
Bourdeaux  are  to  be  preferred.  The  spirituous  wines  of  Spain, 
Portugal,  and  Sicily,  if  used,  should  be  largely  diluted.  Seltzer 
water  will  often  prove  a  good  substitute  for  wine. 

It  would  be  a  wise  rule  for  all  dyspeptic  patients  to  abstain 
entirely  from  every  thing  that  is  brought  to  table  in  the  form  of 
dessert.  This  advice  I  feel  cannot  be  urged  too  strongly ;  nor  can 
the  dyspeptic  patient  have  too  forcibly  impressed  upon  his  mind 
that  temperance  and  abstemiousness  are  the  best  physic.  The  be- 
lief so  generally  entertained  that  medicine  can  counteract  the  effects 
of  habitual  errors  in  regimen,  should  be  regarded  as  mere  sophistry. 
There  is  but  one  road  to  a  permanent  cure  in  these  cases,  and  he 
who  shall  steadily  pursue  it  long  enough  to  feel  its  advantages,  in 
the  restoration  of  mental  and  bodily  energy,  will  not  easily  be 
induced  to  deviate  from  it  again. 

Exercise  in  the  open  air  is  one  of  the  greatest  advantages  which 
a  winter  residence  in  the  South  affords ;  and  the  dyspeptic  invalid 
should  take  full  advantage  of  it.  Walking  and  riding  on  horseback 
are  the  best  kinds  of  exercise,  but  neither  should  be  carried  so  far 
as  to  produce  over-fatigue.  When  the  irritation  of  the  stomach  is 
complicated  with  that  of  the  bronchial  membrane,  riding  should  be 
chiefly  relied  on  for  exercise.  Exercising  the  arms  every  morning 
is  very  useful  in  dyspeptic  complaints;  for  this  purpose  the  clubs 
so  much  used  in  India  are  much  to  be  preferred  to  dumb-bells. 
While  on  the  subject  of  exercise,  I  must  not  omit  to  mention 
that  on  the  water,  which  to  many  invalids  is  very  soothing  and 
beneficial. 

Friction  of  the  whole  surface  of  the  body,  night  and  morning,  is 
a  valuable  remedy,  and  is  especially  suited  to  the  sedentary,  as  be- 
ing the  best  substitute  for  exercise.  For  those  whose  occupation 
compels  them  to  a  sedentary  life,  in  our  damp  and  cold  climate, 
there  are  few  remedies  more  useful,  though  none  more  neglected, 
than  friction.  The  diligent  use  of  this,  and  sponging  the  surface 
with  cold  or  tepid  vinegar  and  water,  or  the  shower-bath  daily, 
during  summer,  and  the  use  of  the  warm  bath  at  all  seasons,  regu- 
lated according  to  the  constitution  of  the  patient,  form  a  powerful 
combination  of  means  for  maintaining  the  health  of  such  persons  as 
are  constrained  by  circumstances  to  forego  the  natural  modes  of 
bodily  exercise  in  the  open  air ;  and  the  same  measures  are  often 
singularly  efficacious  in  restoring  the  diminished  energy  of  the 
skin  and  digestive  organs  in  cases  of  nervous  and  atonic  dyspepsia. 
They  should  not,  however,  be  considered  as  superseding  exercise 
in  the  open  air  when  at  all  practicable,  For  the  want  of  exercise, 
nothing  can  fully  compensate ;  but  the  means  which  I  have  sug- 


DISORDERS  OF  THE  DIGESTIVE  ORGANS.  29 

gested  will  in  some  degree  supply  its  place,  and  will  always  prove 
beneficial  to  the  class  of  invalids  for  whom  I  am  now  writing.1 

Cold  and  damp  weather  is  particularly  injurious  in  dyspepsia, 
more  especially  in  the  nervous  and  atonic  forms,  in  which  coldness 
of  the  surface  and -extremities,  is  a  prominent  symptom.  The  use 
of  warm  clothing,  therefore,  forms  an  essential  part  of  the  treatment 
in  such  cases.  Flannel  should  be  worn  next  the  skin  during  the 
day;  and  when  any  change  of  dress  is  made  in  the  summer,  it 
should  be  effected  gradually  and  with  great  caution ;  and  the 
change  of  weather  in  autumn  should  always  be  anticipated  by  a 
return  to  warmer  clothing.  These  precautions  are  equally  neces- 
sary in  a  southern  climate. 

All  these  measures  tend  directly  to  maintain  a  free  circulation 
through  the  extremities  and  surface, — an  object  of  the  greatest  im- 
portance in  the  treatment  of  dyspepsia.  Indeed,  I  conceive  that  it 
is  chiefly  in  consequence  of  the  active  circulation  on  the  surface 
during  the  warmth  of  summer,  and  being  more  in  the  pure  open 
air,  that  so  many  feeble,  dyspeptic,  and  nervous  invalids  find  them- 
selves better  and  get  stouter  during  that  season,  and  that  the  hypo- 
chondriac's mind  is  freed  of  half  the  gloom  which  oppressed  it; 
whilst,  on  the  contrary,  it  is  from  the  diminished  activity  of  the 
circulation  in  the  surface  and  extremities,  and  the  consequent  con- 
gestion of  the  internal  organs,  and  also  from  breathing  so  constantly 
the  comparatively  impure  air  of  a  room,  that  such  patients  languish 
during  nine  months  of  the  year  in  this  country.  On  this  principle, 
much  of  the  advantage  derived  from  passing  the  winter  in  a  mild 
climate  may  be  explained. 

If  the  measures  which  I  have  just  recommended  be  steadily 
adopted,  little  medicine  will  be  required.  It  will  at  all  times  be 
necessary  to  attend  to  the  state  of  the  bowels  ;  though  the  dyspeptic 
invalid  should  endeavour  to  bring  them  to  act  regularly  by  proper 
regimen  and  exercise  rather  than  by  medicine.  That  this  may 
generally  be  done,  even  in  very  obstinate  cases  of  constipation,  I 
am  satisfied  from  experience ;  and  in  young  persons  regularity  of 
bowels  may  often  be  induced,  in  a  much  shorter  period  than  could 
be  believed.  In  this  respect  a  change  of  climate  often  acts  very 
beneficially. 

I  once  more  beg  that  it  may  be  clearly  understood  that  I  do  not 
recommend  traveling,  or  a  residence  in  the  south  of  Europe,  to 
patients  labouring  under  the  more  acute  forms  of  gastritic  dys- 
pepsia ;  much  less  do  I  advise  such  a  measure  to  those  labouring 
under  organic  disease  or  chronic  inflammation  of  any  of  the  abdo- 
minal viscera.  When  organic  changes  have  taken  place,  or  inflam- 
mation is  established  in  any  organ  of  importance  to  life,  a  long 

*For  the  most  judicious  instructions  on  this  subject,  the  reader  is  referred 
to  Dr.  Combe's  work  on  the  Principles  of  Physiology  applied  to  the  Pre- 
servation of  Health,  and  to  the  Improvement  of  Physical  and  Mental 
Education,  Eighth  Edition;— a  book  which  no  family  should  be  without. 


30  CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

journey  is  more  likely  to  increase  than  diminish  the  evil.  When- 
ever inflammation  exists  in  a  degree  sufficient  to  excite  the  circula- 
tion, in  whatever  organ  or  structure  it  may  be  situated,  I  consider 
rest  an  essential  part  of  the  treatment,  although  it  is  much  neglected 
in  chronic  diseases. 

The  nature  of  a  disease  should  be  well  ascertained  before  the 
patient  is  urged  to  take  active  exercise,  or  is  permitted  to  undertake 
a  long  journey.  If  the  disease  be  of  a  purely  nervous  character, 
active  exercise  in  the  open  air  forms  a  most  effectual  means  of 
restoring  the  health  ;  whereas,  if  the  symptoms  depend  on  chronic 
inflammation,  the  same  measure  will  scarcely  fail  to  increase  it,  and, 
as  I  have  frequently  had  occasion  to  observe,  may  even  convert  a 
chronic  into  an  acute  disease.  The  distinction  is,  therefore,  very 
important,  but  it  is  one  which  I  have  reason  to  know  is  not  gene- 
rally attended  to. 

After  a  winter  passed  in  a  mild  climate,  a  judicious  course  of 
mineral  waters  will  prove  a  very  efficient  remedy  in  cases  of  dys- 
peptic disease,  dependent  upon,  or  complicated  with  a  congested 
state  of  the  liver  and  other  abdominal  organs,  and  a  disordered  state 
of  all  the  secretions.  For  my  views  on  this  subject,  I  must  refer  to 
the  Appendix  on  MINERAL  WATERS. 


PULMONARY  CONSUMPTION. 

There  is  no  subject  connected  with  health,  possessing  greater 
claims  to  attention  than  that  which  relates  to  the  class  of  diseases  of 
which  Pulmonary  Consumption  is  one  of  the  most  frequent  and 
fatal  forms ;  at  the  same  time,  there  is  perhaps  none  concerning 
which  the  public  is  less  accurately  informed. 

In  the  former  editions  of  this  work,  I  entered  pretty  fully  into  the 
causes,  nature,  and  progress  of  Pulmonary  Consumption  ;  but  hav- 
ing lately  published  a  separate  Treatise  on  the  subject,  I  shall  con- 
fine myself,  on  the  present  occasion,  to  a  brief  description  of  the 
constitutional  disorder,  TUBERCULOUS  CACHEXY,  which  precedes 
consumption,  and  to  a  notice  of  the  more  evident  indications  by 
which  a  tuberculous  state  of  the  lungs  may  be  recognised. 

TUBERCULOUS  CACHEXY  was  employed,  in  the  first  edition  of 
this  work,  to  designate  that  morbid  state  of  health  which  precedes, 
and  in  fact,  constitutes  the  essential  predisposing  cause  of  pulmo- 
nary consumption.  The  term  has  been  generally  adopted  by  the 
profession,  but  the  disorder  itself  has  not  yet  received  that  degree 
of  consideration  which  its  importance  demands.  The  attention  is 
still  too  exclusively  directed  to  the  pulmonary  disease,  and  too  little 
notice  taken  of  the  constitutional  affection  ;  although  it  is  only  on 
the  proper  treatment  of  the  latter  that  we  can  rest  our  hopes  of  suc- 
cess,— all  efforts  to  cure  the  former  having  been  as  yet  compara- 
tively of  little  avail.  It  is  of  the  utmost  consequence,  therefore, 


PULMONARY  CONSUMPTION.  31 

that  we  should  be  able  to  distinguish  the  leading  features  by  which 
the  constitutional,  or  curable  period  of  the  disorder  may  be  recog- 
nised. 

The  aspect  and  general  appearance  of  a  young  person  labouring 
under  tuberculous  cachexy,  are  generally  well  marked.  The 
countenance  is  pale,  with  a  sallow  cast,  although  it  is  in  this  respect 
subject  to  considerable  variations.  In  persons  naturally  of  a  florid 
complexion  the  changes  are  often  very  remarkable :  at  one  time 
general  paleness,  with  a  faded  expression  of  countenance ;  at  an- 
other, an  irregular  mixture  of  white  and  red  prevails  ;  but  in  place 
of  the  gradations  by  which  these  colours  pass  into  each  other  in 
health,  they  terminate  abruptly,  giving  the  face  a  blotched  or  spotted 
appearance.  Sallow  complexions  assume  a  peculiarly  dull,  leaden 
hue  ;  there  is  paleness  or  lividity  of  the  lips  ;  the  eyes  have  gene- 
rally a  dull,  pearly  aspect;  and  the  whole  countenance  commonly 
appears  sunk  and  languid.  These  indications,  as  I  have  already 
said,  are  very  variable,  arid  may  pass  for  many  months  unnoticed, 
except  by  the  immediate  relations  or  the  physician  ;  but  as  the 
constitutional  disorder  increases  they  become  evident  to  the  most 
cursory  observer. 

Upon  close  examination,  the  skin  of  such  a  patient  will  be  found 
in  an  unhealthy  condition  :  either  harsh  and  dry,  or  moist,  clammy, 
and  relaxed,  its  colour,  too,  is  often  changed  to  a  sallow,  and,  in 
some  cases,  to  a  dirty  yellowish  hue ;  and,  except  on  the  cheeks, 
there  is  always  a  deficiency  of  red  vessels.  In  some  hereditary 
cases,  particularly  in  females  of  a  fair  and  delicate  complexion,  the 
skin  has  a  semi-transparent  appearance,  resembling  wax-work,  and 
the  veins  may  be  seen  distinctly  through  it.  The  temperature, 
also,  of  the  surface  arid  extremities  is  below  the  standard  of  health. 

The  digestive  organs  are  very  generally  deranged,  though  the 
degree  and  nature  of  the  derangement  differ  materially  in  different 
cases.  The  tongue  is  more  or  less  furred ;  the  point  and  margin 
are  redder  than  natural,  and  often  studded  with  enlarged  fungiform 
papillaB  of  a  still  brighter  hue.  In  a  class  of  cases,  of  much  rarer 
occurrence,  the  tongue  is  clean  and  natural  in  its  appearance,  and 
the  mucous  membrane  of  the  internal  fauces  pale.  I  have  remarked 
this  chiefly  in  females,  in  whom  the  disease  has  been  owing  to 
hereditary  predisposition,  and  little  complicated  with  gastric  disor- 
der. But  in  by  far  the  greater  proportion  of  cases,  the  functions  of 
the  digestive  organs  are  more  or  less  deranged. 

The  nervous  system  also  partakes  of  the  general  disorder.  There 
is  more  nervous  sensibility  than  is  natural  to  the  patient.  The 
sleep  is  not  sound;  being  disturbed  or  unnaturally  heavy,  and 
rarely  refreshing.  In  the  purer  and  less  complicated  cases  of  here- 
ditary consumption,  there  is  generally  great  serenity  of  mind  ;  the 
spirits  are  of  surprising  buoyancy ;  and  the  hope  of  recovery 
remains  to  the  last.  But  this  state  of  mind  is  a  less  constant  atten- 
dant on  consumption  than  is  generally  believed ;  especially  when 
it  has  been  preceded  by  long  continued  disorder  of  the  digestive 


32  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

organs.  In  such  cases  there  is  oftentimes  great  impatience,  and 
irritability  of  temper. 

The  state  of  the  circulation  is  subject  to  great  variety.  In  here- 
ditary cases,  the  power  of  the  heart  is  commonly  under  the  ordi- 
nary standard,  whilst  the  frequency  of  the  pulse  is  generally  above 
it,  and  palpitation  is  a  frequent  symptom.  The  circulation  is  in 
general  feebly  carried  on  through  the  extreme  vessels,  as  is  shown 
by  the  condition  of  the  skin  already  noticed,  and  the  tendency  to 
coldness  of  the  extremities.  This  state  of  the  surface  and  extremi- 
ties is  a  very  constant  attendant  on  abdominal  congestion,  compli- 
cated with  an  irritated  condition  of  the  gastro-intestinal  mucous 
surfaces ;  and  hence  it  is  generally  more  evident,  according  as  the 
disorder  of  the  digestive  organs  is  more  considerable. 

Although,  in  the  great  majority  of  cases,  the  indications  of  dis- 
ease just  enumerated  are  sufficiently  apparent  during  a  considerable 
period  before  the  occurrence  of  pulmonary  disease,  cases  do  occa- 
sionally occur,  and  the  subjects  are  chiefly  delicate  young  females, 
where  tuberculous  disease  is  indicated  by  such  faint  signs,  and 
steals  on  so  imperceptibly,  that  the  patient  may  be  on  the  brink  of 
the  grave,  before  the  friends  are  aware  of  the  existence  of  danger  ; 
but  this  is  rare,  and  will  be  still  more  so,  when  the  symptoms 
which  indicate  the  approach  of  this  insidious  disease  are  more  gene- 
rally known  and  attended  to. 

Tuberculous  cachexy  is  sometimes  complicated  with  chlorosis, 
and  in  such  cases  the  latter  is  often  considered  the  primary  disease, 
the  error  not  being  discovered  till  those  means  so  successfully,  in 
general,  employed  to  combat  it,  are  found  to  produce  a  very  tem- 
porary benefit  only.1 

The  disordered  state  of  health  which  I  have  just  described  may 
manifest  itself  in  the  child  at  birth,  or  it  may  be  induced  at  any 
period  of  life  by  the  exciting  causes  to  be  presently  noticed ;  al- 
though the  operation  of  these  is  more  rapid  before  the  body  has 
acquired  its  full  maturity,  than  at  a  later  period  of  life. 

Hereditary  Origin. — A  patient  labouring  under  tuberculous 
cachexy,  entails  on  his  offspring  a  constitutional  predisposition  to 
consumption.  But  it  is  a  grievous,  although  a  very  common  error, 
to  suppose  that  this  predisposition  is  derived  from  consumptive  and 
scrofulous  parents  only.  The  offspring  of  persons  labouring  under 
a  deranged  state  of  health,  it  matters  not  from  what  cause,  are  very 
generally  predisposed  to  tuberculous  diseases.  When  this  truth  is 
generally  recognised  and  acted  on,  a  greatly  improved  state  of  the 
public  health  will  be  the  consequence. 

From  whatever  causes  the  hereditary  predisposition  may  have 
originated,  the  earlier  in  life  the  means  of  correcting  it  are  adopted 
the  more  successful  will  they  be.  Our  efforts  to  improve  the  health 
should  commence  with  the  birth  of  the  infant,  and  be  continued 

1  In  Dr.  Ashwell's  Practical  Treatise  on  the  Diseases  Peculiar  to  Wo- 
men, will  be  found  some  judicious  remarks  on  this  state  of  disease. 


PULMONARY  CONSUMPTION.  33 

till  it  has  reached  maturity.  But  the  errors  committed  in  the  nur- 
sery, and  too  often  continued  during  childhood  and  youth,  rather 
tend  to  confirm  and  augment  the  hereditary  delicacy ;  and  such 
will  be  the  case  till  parents  are  taught  to  entertain  more  correct 
views  respecting  the  means  of  promoting  the  health  of  their  off- 
spring.1 

Exciting  Causes.-^- Whatever  deteriorates  the  health  may  lead 
to  tuberculous  cachexy  ;  residence  in  a  low,  damp,  and  chilly 
atmosphere ;  long  confinement  to  close,  ill  ventilated  rooms,  whe- 
ther nurseries,  school-rooms,  or  manufactories  ;  deficient  exercise 
in  the  open  air ;  improper  food,  either  deficient  in  quantity  or  of 
innutritious  quality ;  or  the  habitual  use  of  an  overstimulating 
diet.  In  short,  imperfect  digestion  and  assimilation  may  induce 
tuberculous  cachexy  ;  and  the  earlier  in  life  these  causes  are  ap- 
plied the  more  rapidly  in  general  will  their  effects  be  manifested. 
The  offspring  of  the  healthiest  parents  may  thus  become  tubercul- 
ous in  early  life,  if  long  exposed  to  the  exciting  causes  enumerated. 

I  shall  now  endeavour  to  state,  with  as  much  precision  as  the 
nature  of  the  subject  admits,  what  may  reasonably  be  expected 
from  change  of  climate  in  tuberculous  cachexy,  and  in  consump- 
tion at  the  different  stages  of  its  progress,  and  under  its  different 
complications. 

For  the  removal  of  the  deranged  state  of  the  health,  which  has 
been  shown  to  precede  consumption,  a  change  to  a  milder  climate 
is  a  very  powerful  remedy,  when  aided  by  such  other  means  as  the 
peculiar  circumstances  of  the  case  may  require.  Before  making 
such  a  change,  however,  the  functions  more  evidently  deranged 
should,  as  far  as  possible,  be  restored  to  a  healthy  state. 

In  a  large  proportion  of  cases,  the  functions  of  the  digestive 
organs  and  skin,  as  I  have  already  remarked,  are  deranged,  and, 
until  they  are  improved,  we  shall  make  little  progress  in  remedying 
the  constitutional  disorder,  even  under  the  influence  of  the  best 
climate.  But  the  means  employed  for  effecting  this  should  be 
directed  with  judgment  and  moderation.  It  must  be  recollected 
that  we  have  to  deal  with  a  constitution  either  hereditarily  weak, 
or  which  has  been  brought  into  its  present  condition  by  a  long 
series  of  morbid  actions,  and  cannot  be  at  once  forced  back  into  a 
healthy  state.  Even  when  inflammation  exists,  we  must  keep  in 
rnind  that  it  is  inflammation  in  a  disordered  habit,  and  apply  our 
remedies  accordingly.  For  if  the  strength  is  now  broken  up,  and 
the  balance  of  the  circulation  suddenly  disturbed  by  debilitating 
remedies,  the  system  may  lapse  rapidly  into  tuberculous  cachexy. 
On  the  other  hand,  stimulating  or  irritating  remedies  will  be  equally 
pernicious.  In  the  cases  now  under  consideration,  local  congestion 

1  Dr.  Combe's  recent  work  on  the  Physiological  and  Moral  Management 
of  Infancy,  will  effect  a  vast  improvement  in  nursery  management,  and  in 
the  health  of  children.  It  is  the  most  valuable  work  on  the  subject  of  health 
which  has  ever  been  published,  and  no  parent  capable  of  reading  his  own 
language  should  be  without  it. 

L— c  3  dark 


34  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

and  irritation  often  exist  with  general  debility ;  and  it  requires 
more  judgment  to  manage  this  pathological  state,  than  almost  any 
other  with  which  I  am  acquainted.  The  principal  object,  in  such 
cases,  is  to  promote  a  more  free  and  regular  distribution  of  the  cir- 
culating fluids  through  the  parts  in  which  they  have  been  defi- 
cient, and  to  relieve  those  parts  or  organs  which  have  been  over- 
loaded. This  will  be  best  done  by  a  mild,  nutritious  diet,  suited 
to  the  state  of  the  digestive  organs  ;  by  exercise  in  the  open  air, 
especially  on  horseback,  proportioned  to  the  strength  of  the  patient; 
by  the  use  of  the  warm  bath  ;  by  cold  sponging,  and  friction  of  the 
surface,  especially  on  the  chest  and  extremities.  In  short,  the 
whole  system  being  deranged,  we  must  not  content  ourselves  by 
directing  attention  to  one  or  two  disordered  functions  ;  but,  by  ope- 
rating on  all,  endeavour  to  raise  the  standard  of  health  generally. 

The  removal  of  gastric  or  bronchial  irritation,  when  it  exists, 
and  the  regulation  of  the  bowels,  are  the  circumstances  which 
chiefly  require  the  employment  of  medicines.  The  proper  appli- 
cation of  these  in  each  individual  case,  must  depend  on  the  judg- 
ment of  the  medical  attendant. 

The  deranged  functions  having  been  corrected,  and  the  general 
health  improved  as  much  as  the  circumstances  of  the  case  admit, 
the  patient  may  change  his  climate  with  well  grounded  prospects 
of  permanent  advantage. 

Unfortunately,  it  too  often  happens,  that  the  period  of  constitu- 
tional disorder,  which  we  have  just  been  considering,  is  permitted 
to  pass  ;  and  it  is  not  until  symptoms  of  irritation  or  impeded  func- 
tion in  the  lungs,  such  as  cough,  difficult  breathing,  or  spitting  of 
blood,  appear,  that  the  patient  or  relations  are  alarmed,  and  that 
fears  are  expressed  that  the  chest  is  "threatened."  Such  symp- 
toms are  but  too  sure  indications  that  tuberculous  disease  has 
already  commenced  in  the  lungs.  It  may.  indeed,  be  difficult,  in 
some  cases,  to  ascertain  the  positive  existence  of  this,  although  by 
a  careful  examination  of  the  chest,  and  an  attentive  consideration 
of  all  the  circumstances  of  the  case,  we  shall  seldom  err  in  our 
diagnosis;  and  it  need  not,  at  any  rate,  affect  our  practice;  as  a 
strong  suspicion  of  the  presence  of  tubercles  should  lead  113  to  adopt 
the  same  precautions,  as  the  certainty  of  their  existence. 

When  tuberculous  matter  is  deposited  in  the  lungs,  the  circum- 
stances of  the  patient  are  materially  changed.  We  have  the  same 
functional  disorders  which  existed  in  the  former  state  :  and  we  have 
also  pulmonary  disease,  predisposing  to  a  new  series  of  morbid 
actions — to  bronchial  affections,  haemoptysis,  inflammation  of  the 
pleura,  and  lungs,  &c.,  which  calls  for  important  modifications  in 
the  plan  of  treatment.  Removal  to  a  mild  climate,  especially  if 
effected  by  means  of  a  sea-voyage  under  favourable  circumstances, 
may  still  be  useful,  on  the  same  principle  as  in  the  former  case — 
namely,  as  a  means  of  improving  the  general  health,  of  preventing 
inflammatory  affections  of  the  lungs,  and  even  perhaps  arresting 
the  progress  of  the  disease. 


PULMONARY  CONSUMPTION.  35 

When  consumption  is  fully  established — that  is,  when  there  is 
extensive  tuberculous  disease  in  the  lungs,  little  benefit  is  to  be 
expected  from  change  of  climate;  and  a  long  journey  will  almost 
certainly  increase  the  sufferings  of  the  patient,  and  hurry  on  the 
fatal  termination.  Under  such  circumstances,  therefore,  the  pa- 
tient will  act  more  judiciously  by  contenting  himself  with  the  most 
favourable  residence  which  his  own  country  affords,  or  even  by 
remaining  arnid  the  comforts  of  home,  and  the  watchful  care  of 
friends.  And  this  will  be  the  more  advisable  when  a  disposition 
to  sympathetic  fever,  to  inflammation  of  the  lungs,  or  to  haemopty- 
sis, has  been  strongly  manifested. 

It  is  natural  for  relations  to  cling  to  that  which  seems  to  afford 
even  a  ray  of  hope  ;  but  did  they  know  the  discomforts,  the  fatigue, 
the  exposure,  and  irritation,  necessarily  attendant  on  a  long  journey 
in  the  advanced  period  of  consumption,  they  would  shrink  from 
such  a  measure.  The  medical  adviser,  also,  when  he  reflects  upon 
the  accidents  to  which  such  a  patient  is  liable,  should  surely  hesi- 
tate ere  he  condemns  him  to  the  additional  evil  of  expatriation  ; 
and  his  motives  for  hesitation  will  be  increased  when  he  considers 
how  often  the  unfortunate  patient  sinks  under  the  disease,  before 
the  place  of  destination  is  reached ;  or,  at  best,  arrives  there  in  a 
worse  condition  than  when  he  left  his  own  country,  and  doomed 
shortly  to  add  another  name  to  the  long  and  melancholy  list  of  his 
countrymen  who  have  sought,  with  pain  and  suffering,  a  distant 
country,  only  to  find  in  it  a  grave.  When  the  patient  is  a  female, 
the  objections  to  a  journey  apply  with  increased  force.  In  these 
advanced  cases  the  patient's  sufferings  may  often  be  alleviated,  and 
life  prolonged,  by  confinement  to  apartments  kept  at  a  regulated 
temperature. 

There  are,  however,  cases  of  chronic  consumption,  in  which  the 
disease  of  the  lungs,  even  though  arrived  at  a  very  advanced  stage, 
may  derive  benefit  from  a  mild^climate.  The  tuberculous  affection 
in  such  persons  is  generally  limited  to  a  small  portion  of  the  lungs, 
and  the  system  sympathises  little  with  it.  In  instances  of  this 
kind,  a  residence  for  some  time  in  a  mild  climate,  especially  when 
aided  by  proper  regimen,  may  be  the  means  of  prolonging  life. 
Likewise,  in  those  fortunate  but  unhappily  rare  cases,  in  which 
the  disease  in  the  lungs  has  ceased  to  extend,  and  a  long  period 
must  elapse  before  the  work  of  reparation  is  completed,  a  mild  cli- 
mate will  be  of  considerable  service  by  improving  the  general 
health,  and  preserving  the  patient  from  the  operation  of  many 
causes,  likely  to  renew  irritation  in  the  lungs,  and  to  which  he 
would  necessarily  be  exposed  in  this  country. 

In  such  cases,  life  may  be  preserved  for  many  years  by  a  con- 
stant residence  in  a  mild  climate,  and  by  sedulously  avoiding,  at 
the  same  time,  whatever  is  calculated  to  produce  congestion,  or  ex- 
cite inflammatory  disease  in  the  lungs.  During  my  residence 
abroad,  I  met  with  several  invalids  labouring  under  this  chronic 

3* 


36 


ipffii 


CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 


form  of  disease,  who  passed  their  winters  in  Italy  with  infinitely 
more  comfort  and  enjoyment  of  life  than  in  England. 

Choice  of  Climate. — When  change  of  climate  is  decided  on,  the 
next  subject  which  naturally  presents  itself  for  consideration,  re- 
gards the  selection  of  that  which  is  most  suitable  to  the  case.  The 
question  has  been  often  put  to  me — which  is  the  best  climate? 
The  truth  is,  no  one  climate  or  situation  is  the  best  in  all  cases.  In 
a  subsequent  part  of  this  work  will  be  found  the  characters  of  the 
different  climates  usually  resorted  to  by  invalids,  and  a  compara- 
tive estimate  of  their  merits.  With  regard  to  the  climates  of  the 
south  of  France  and  of  Italy,  I  may  here  observe,  that  for  con- 
sumptive invalids,  in  whom  there  exists  much  sensibility  to  harsh 
and  keen  winds,  and,  more  especially,  if  immediate  vicinity  to  the 
sea-coast  is  known  to  disagree,  Rome  or  Pisa  is  the  best  situation 
for  a  winter  residence.  When,  on  the  contrary,  the  patient  labours 
under  a  languid,  feeble  circulation,  with  a  relaxed  habit,  and  a  dis- 
position to  congestion  or  to  hemorrhage,  rather  than  to  inflamma- 
tion, and,  more  especially,  when  the  sea-air  is  known  by  experience 
to  agree,  Nice  deserves  the  preference.  In  cases  complicated  with 
gastritic  dyspepsia,  however,  Nice  is  an  improper  residence:  its 
climate  being  decidedly  inimical  to  such  a  state.  The  climate  of 
Hyeres  may  be  considered  as  nearly  similar  to  that  of  Nice.  The 
influence  of  such  a  morbid  condition  of  stomach,  in  modifying  all 
other  diseases,  is  sufficient  to  claim  for  it  the  chief  consideration  in 
deciding  upon  the  particular  climate ;  although,  I  fear,  it  is  but 
seldom  thought  of.  Judging,  however,  from  experience,  I  should 
say,  that  where  this  state  of  the  stomach  exists,  a  climate  which  is 
unsuited  to  it  will  do  the  patient  little  good,  whatever  may  be  the 
ostensible  disease  for  which  he  is  sent  abroad. 

With  those  cases  of  chronic  consumption,  therefore,  to  which  I 
have  alluded,  and  which,  according  to  my  observation,  are  almost 
invariably  complicated  with,  and,  I  believe,  in  a  large  proportion  of 
cases,  chiefly  induced  by  disorder  of  the  digestive  organs,  Nice  will 
decidedly  disagree.  Besides,  such  patients  have  generally  an  irri- 
tated state  of  the  bronchial  membrane,  a  dry  skin,  and  a  morbid 
degree  of  sensibility  of  the  nervous  system — in  all  of  which  states 
that  place  is  unfavourable.  Rome  or  Pisa  will  agree  better  with 
this  class  of  invalids. 

But  the  climate  which,  of  all  others,  I  consider  the  best  suited  to 
consumptive  patients  generally,  is  that  of  Madeira.  It  will  be  seen 
by  a  reference  to  the  meteorological  tables  in  the  Appendix,  and 
from  the  comparisons  drawn,  in  the  article  on  Madeira,  between 
the  climate  of  this  island  and  that  of  the  different  situations  on  the 
continent  of  Europe,  respecting  which  we  have  good  information, 
that  the  winter  temperature  is  considerably  higher  and  more  equa- 
ble, and  the  summer  heat  much  more  moderate  than  at  any  of  these 
places.  For  such  consumptive  patients,  therefore,  as  are  likely  to 
derive  benefit  from  climate,  I  consider  that  of  Madeira  altogether 


PULMONARY  CONSUMPTION.  37 

the  best.  And  this  opinion  does  not  rest  merely  on  a  consideration 
of  the  physical  qualities  of  the  climate,  but  is  warranted  by  the  ex- 
perience of  its  effects.  Madeira  has  also  this  advantage  over  all  the 
places  in  the  south  of  Europe — that  the  patient  may  reside  there 
during  the  whole  year,  and  thus  avoid  the  inconveniences,  and 
even  risks,  attending  a  long  journey,  to  which  consumptive  inva- 
lids, who  pass  the  winter  in  Italy,  are  exposed.  The  summer  cli- 
mate of  the  whole  shores  and  islands  of  the  Mediterranean,  is  un- 
suited  to  consumptive  invalids ;  and,  indeed,  is  known  by  experience 
to  be  so  pernicious  to  them,  that  sailors  and  soldiers  attacked  with 
the  disease  in  the  Mediterranean  fleet,  and  garrisons  of  Malta,  &c., 
are  sent  to  England  on  the  approach  of  summer. 

The  two  places  which,  from  the  character  of  their  climate,  ap- 
proach most  nearly  to  Madeira,  are  Teneriffe  and  the  Azores. 
During  the  winter,  the  temperature  of  Santa  Cruz,  on  the  southern 
coast  of  Teneriffe,  is  several  degrees  higher  than  at  Funchal ;  and, 
in  this  respect,  would  prove  a  superior  winter  climate  for  some 
pulmonary  invalids. 

The  climate  of  Bermudas  is  changeable,  and  holds  out  no  ad- 
vantage to  the  consumptive  invalid.  That  of  the  Azores,  on  the 
contrary,  is  remarkably  mild  arid  equable,  and  suitable  to  cases  in 
which  a  soft  and  rather  humid  atmosphere  is  indicated. 

But  various  circumstances  require  to  be  taken  into  consideration 
before  we  decide  upon  a  particular  climate  in  any  individual  case. 
The  age  and  constitution  of  the  patient,  the  peculiarities  and  com- 
plications of  the  disease ;  his  ability  to  bear  traveling,  or  a  sea- 
voyage  ;  the  means  at  his  command,  and  the  friends  by  whom  he 
can  be  attended,  are  circumstances  which  should  be  taken  into 
account,  in  weighing  the  comparative  advantages  of  different 
places,  and  the  inconveniences  attending  all  of  them,  when  com- 
pared with  the  comforts  and  resources  of  home.  These  collateral 
circumstances  may  render  it  proper  to  recommend  change  of  cli- 
mate to  one  patient,  when  another,  to  whose  case  such  a  measure 
is  equally  applicable,  will  be  better  advised  to  remain  in  his  own 
country. 

The  winter  climates  in  England  most  favourable  to  consump- 
tive patients  are  those  of  Torquay,  Undercliff,  Penzance,  Clifton 
and  Hastings.  The  choice  among  these  places  will  depend  upon 
the  nature  of  the  case,  and  especially  upon  the  condition  of  the 
digestive  organs.  For  persons  of  an  inflammatory  constitution, 
with  a  disposition  to  gastritic  dyspepsia,  Torquay  will  form  the 
best  residence,  while  it  will  as  decidedly  disagree  with  persons  of  a 
very  relaxed  habit,  and  subject  to  copious  secretions  from  the  mu- 
cous membranes,  or  to  atonic  dyspepsia.  Such  patients  will  bear 
the  climate  of  Torquay  for  a  very  short  time  only.  What  has  been 
said  of  Torquay,  applies  with  equal  force  to  Penzance,  and  the 
other  parts  of  the  Land's  End.  Underfcliff,  Hastings,  and  Clifton, 
will  form  preferable  residences  in  the  constitutions  referred  to. 

In  some  cases,  the  relation  of  the  disease  to  the  climate  is  so 


38  CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

nicely  balanced,  that  it  may  be  advantageous  to  send  the  patient 
for  a  few  months  in  the  early  part  of  winter  to  one  place,  and  the 
remaining  part  of  the  season  to  another.  Torquay,  for  example, 
may  suit  remarkably  well  for  two  or  three  months,  at  the  end  of 
which  time  it  may  be  advantageous  for  the  patient  to  change  to  a 
less  relaxing  climate.  The  winter  at  Torquay,  or  Penzance,  and 
the  spring  at  Clifton  will  suit  some  patients  much  better  than  con- 
tinuing the  whole  season  at  any  one  of  these  places.  For  the  par- 
ticular character  of  their  climates,  and  effects  on  disease,  I  must 
refer  to  the  second  part  of  this  work. 

During  the  summer,  great  advantage  will  be  derived  from  fre- 
quent change  of  place  in  almost  all  cases,  as  will  be  pointed  out  in 
the  article  on  summer  residences. 

There  is  one  circumstance  connected  with  the  residence  of  con- 
sumptive patients,  concerning  which  the  profession  are  not  quite 
agreed — I  mean  the  preference  given  to  a  sea-side,  or  an  inland 
situation.  We  have  indeed,  no  very  satisfactory  comparisons  on 
this  subject,  in  which  the  nature  of  the  climate,  occupations,  habits 
of  life,  &c.,  of  the  inhabitants  have  been  fairly  arid  fully  taken  into 
account,  so  as  to  enable  us  to  judge  how  far  the  frequency  of  con- 
sumption, in  any  particular  place,  may  be  connected  with  the  na- 
ture of  the  climate,  and  how  much  may  depend  on  the  mode  of 
living,  &c.  The  question  is  certainly  a  very  difficult  one,  and  in- 
volves a  great  variety  of  circumstances  not  easily  analysed  ;  hence 
it  is,  that  we  have  little  more  than  opinions,  formed  from  imperfect 
data  on  the  subject.  From  all  that  I  have  been  enabled  to  learn 
and  observe,  consumption  is,  I  think,  cceteris  paribuSj  more  fre- 
quent on  the  sea-coast  than  in  the  interior  ;l  still  the  greater  mild- 
ness of  many  maritime  places,  as  of  those  on  the  south  and  south- 
west coasts  of  England,  may  more  than  compensate  for  this  differ- 
ence, especially  when  these  places  are  resorted  to  for  a  part  of  the 
year  only. 

In  Italy,  Rome  is  the  only  place,  frequented  by  invalids,  suffi- 
ciently remote  from  the  sea  to  be  considered  as  having  an  inland 
climate  ;  and  here  the  comparison  is  certainly  in  favour  of  the  in- 
land situation.  But  my  impression  is,  that  there  is  less  difference 
between  the  sea-side  and  inland  situations,  in  that  range  of  latitude, 
than  further  north ;  perhaps  owing  to  the  greater  dryness  of  the 
sea-side  in  southern  climates.  Of  two  climates,  the  physical  cha- 
racters of  which  were  alike,  the  one  on  the  sea-shore,  and  the  other 
inland,  I  should  prefer  the  latter  as  a  residence  for  a  consumptive 
patient,  more  especially  if  the  disease  were  in  an  advanced  stage  ; 
but  I  am  ready  to  admit  that  this  opinion  is  unsupported  by  any 
very  accurate  or  numerous  data.  In  America  the  opinions  of  medi- 
cal men  are  greatly  in  favour  of  the  interior. 

1  The  comparisons  in  this  respect,  which  have  been  made  between  the 
sea-coast  and  interior,  of  large  continents,  I  do  not  consider  applicable  to 
small  islands. 


PULMONARY  CONSUMPTION.  39 

The  idea  that  the  air  of  a  marshy  country  is  beneficial  in  con- 
sumption, is  now,  I  believe,  entirely  abandoned.  Scrofula,  and 
even  consumption,  is  more  frequent  in  many  aguish  districts,  than 
in  others  of  a  different  character ;  and  an  attack  of  ague  is  much 
more  likely  to  favour  the  occurrence  of  consumption  than  to  pre- 
vent it. 

A  sea- voyage  is  another  measure,  regarding  which  a  difference 
of  opinion  prevails  among  professional  men.  My  own  opinion  is, 
that  a  voyage  is  generally  beneficial  in  the  early  stage  of  consump- 
tion. The  sickness  and  vomiting  are  highly  useful  in  many  cases, 
and  I  believe,  the  unceasing  motion  of  a  ship,  by  the  constant  ex- 
ercise it  produces,  is  also  very  advantageous.  It  was  to  this  chiefly, 
that  the  celebrated  Gregory  attributed  the  benefit  derived  from  a 
voyage.  Several  striking  instances  of  the  beneficial  effects  of  a 
sea-voyage  in  consumption,  fell  under  my  notice  while  in  Italy ; 
and  Dr.  Peebles,  now  of  Edinburgh,  whose  long  residence  at  Leg- 
horn gave  him  a  favourable  opportunity  of  observing  the  effects  of 
the  voyage  on  consumptive  patients  sent  from  England  to  Pisa, 
met  with  many  examples  of  the  same  kind.  On  examining  the 
notes  of  the  cases,  with  which  Dr.  Peebles  favoured  me,  I  find  that 
haemoptysis  existed  in  every  one  of  them  ;  and  this  was  also  the 
case  in  most  of  the  examples  which  came  under  my  own  observa- 
tion. The  circumstance  of  the  patient  being  subject  to  haemoptysis, 
in  the  early  stage  more  especially,  I  should,  therefore,  consider  as 
affording  no  objection  to  a  sea  voyage.1 

In  the  consumptive  cases,  also,  which  are  complicated  with  pal- 
pitation, or  increased  action  of  the  heart,  whether  purely  functional, 
or  depending  upon  organic  disease,  I  consider  a  voyage  useful,  and 
much  preferable  to  a  land  journey.  There  are  complications,  on 
the  other  hand,  which  render  a  voyage  unadvisable.  When  there 
is  much  nervous  sensibility,  a  strong  disposition  to  headach,  and  an 
irritable  state  of  the  stomach,  a  sea-voyage  will  generally  disagree. 
With  these  exceptions,  I  should  say,  that  a  consumptive  patient,  in 
whose  case  a  foreign  climate  is  likely  to  prove  useful,  had  better 
go  by  sea  than  by  land,  provided  a  vessel  can  be  obtained  with 
good  accommodations.  Much  depends  upon  this  last  circumstance, 
and  much  also  on  the  climate  or  season  in  which  the  voyage  is 
made.  The  motives  for  preferring  a  voyage  to  a  journey  will  be 
still  stronger,  when  the  patient  has  not  the  means  of  traveling  in 
the  most  comfortable  manner.  Sailing  or  cruising  for  some  time 
would  be  still  preferable  to  a  voyage  ;  and  the  Atlantic  is  more 
favourable  for  this  purpose  than  the  Mediterranean.  When  a  long 
voyage  is  objected  to,  shorter  voyages,  under  favourable  circum- 
stances, and  repeated  at  short  intervals,  might  be  of  essential  bene- 
fit. An  objection  to  sea-voyages,  is  the  length  of  time  that  the 
patient  is  necessarily  confined  to  the  close  and  relaxing  air  of  the 

1  See  Dr.  Combe's  Physiology,  &c.,  already  referred  to,  p.  107,  for  a  re- 
markable example  of  the  benefits  of  a  sea-voyage. 


40  CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

sleeping  places  ;  but  this  is  far  more  than  compensated  for  by  the 
facilities  which  he  enjoys  of  being  constantly  on  deck  during  the 
day,  and  there  breathing  the  purest  and  most  salubrious  air.  To 
take  advantage  of  this  with  safety,  however,  let  the  invalid  be  pro- 
vided with  an  ample  store  of  warm  clothing,  and  wrapped  up  suf- 
ficiently to  be  able  to  spend  the  whole  time  of  daylight  on  deck 
without  being  disagreeably  chilled. 

The  measures  which  have  been  recommended  as  necessary  pre- 
parations for  a  long  journey,  are  equally  requisite  in  the  case  of  a 
voyage — much  of  the  benefit  of  which  will  depend  upon  the  con- 
dition in  which  the  patient  is  sent  to  sea,  and  the  regimen  he 
adopts  while  there. 

When  it  is  deemed  proper  to  send  a  consumptive  invalid  abroad, 
his  best  residence  will  be  found  in  one  or  other  of  the  places  which 
have  been  noticed  :  and  when  it  can  be  so  arranged  that  he  may 
change  his  climate  several  times,  it  will  generally  be  to  his  advan- 
tage. When  change  of  climate  is  wisely  adopted  for  the  improve- 
ment of  the  general  health,  and  before  local  disease  is  established, 
a  far  wider  range  may  be  permitted  to  the  traveller.  The  whole 
south  of  Europe  is  open  to  him,  and  if  he  manages  his  voyages 
and  travels  judiciously,  he  may  improve  his  health  more  than  by 
remaining  the  whole  season  in  any  one  place.  But  while  great 
latitude  may  be  allowed,  over-exertion  in  traveling,  and  exposure 
to  harsh  cold  weather,  should  be  avoided,  especially  by  the  more 
delicate,  otherwise  they  may  lose  more  than  they  gain.  The  total 
want  of  proper  accommodation  and  means  of  conveyance  must  also 
limit  the  extent  of  their  wanderings. 

In  short,  general  rules  only  can  be  laid  down  for  such  cases.  In 
the  guidance  of  each  individual,  an  outline  is  all  that  can  be  traced 
by  the  physician  ;  but  the  use  of  a  little  common  sense  and  discre- 
tion on  the  part  of  the  traveller,  will  enable  him  to  fill  up  the  detail 
of  his  tour,  so  as  to  derive  the  maximum  of  benefit  with  the  mini- 
mum of  those  disadvantages  which  are  inseparable  from  all  kinds 
of  traveling. 

With  respect  to  the  length  of  time  requisite  for  a  consumptive 
invalid  to  pass  in  a  mild  climate,  in  order  to  overcome  the  disposi- 
tion to  the  disease,  no  general  rule  can  be  given.  When  the  mea- 
sure is  had  recourse  to  for  the  removal  of  the  disordered  health 
which  precedes  tuberculous  cachexy,  a  single  winter  will  be  of 
great  benefit,  and  possibly  all  that  may  be  necessary.  When  tuber- 
culous cachexy  is  established,  and  still  more,  when  there  is  reason 
to  suspect  the  presence  of  tubercles  in  the  lungs,  several  years  may 
be  requisite,  and  in  some  cases  it  may  be  necessary  to  reside  per- 
manently in  a  mild  climate. 

When,  by  the  influence  of  climate  and  other  measures,  pulmo- 
nary disease  has  been  warded  off,  or  when  it  has  ceased  to  make 
progress,  every  thing  calculated  to  excite  irritation  in  the  lungs 
should  be  carefully  avoided  ;  as  a  tendency  to  a  return  of  the  con- 
stitutional and  local  disorder  remains  long  after  the  symptoms  have 


PULMONARY  CONSUMPTION.  41 

disappeared.  Where  the  disease  has  advanced  a  step  farther,  and 
a  cure  has  nevertheless  been  effected  during  a  residence  in  a  mild 
climate,  the  patient  should  remain  there  for  a  considerable  time 
(some  years  if  possible)  after  every  symptom  of  the  disease  has  dis- 
appeared. The  same  plan  of  treatment,  and  the  same  climate 
which  enabled  the  constitution  to  effect  a  cure,  should  be  continued, 
if  possible,  till  the  respiratory  organs  and  system  have  accommo- 
dated themselves  to  the  new  condition  of  the  parts.  This  may, 
indeed,  be  such  that  the  individual  shall  not  be  able  to  live  in  any 
other  -climate.  Under  whatever  circumstances  he  may  be  placed, 
such  a  person  must  make  up  his  mind  to  live  with  great  regularity 
and  temperance  during  the  remainder  of  his  life.  He  will  bear 
neither  full  living  nor  much  bodily  fatigue;  although  regular  and 
moderate  exercise  in  the  open  air,  and  above  all,  riding  on  horse- 
back, will  be  of  the  greatest  service  to  him.  Fulness  and  excite- 
ment, especially  as  affecting  the  pulmonary  organs,  are  what  he 
has  most  to  dread.  Although  the  disease  has  ceased  to  advance, 
the  lungs  cannot  be  restored  to  their  former  dimensions  ;  they  must 
remain  diminished  in  capacity  in  proportion  to  the  extent  of  tuber- 
culous disease  which  existed.  The  chest  can  therefore  neither  be 
so  fully  expanded,  nor  the  blood  so  freely  circulated  through  the 
lungs  as  before.  Hence,  as  the  capacity  of  the  respiratory  organs 
is  diminished  relatively  to  the  bulk  of  the  body,  there  will  be  a 
constant  tendency  to  a  plethoric  or  congested  state  of  the  pulmo- 
nary system ;  and  if  the  quantity  and  quality  of  the  food,  and 
degree  of  bodily  exertion,  are  not  adapted  to  the  new  condition  of 
the  lungs,  hemorrhage  or  inflammation  of  these  organs  will  be  the 
consequence  ;  and  may  speedily  terminate  a  life,  which,  by  a  rea- 
sonable degree  of  attention  and  prudence,  might  have  been  pro- 
longed many  years.  A  mild  and  moderate  diet,  with  abstinence 
from  every  thing  exciting,  can  alone  preserve  such  persons.  The 
state  of  the  digestive  organs  requires  particular  attention,  as  con- 
gestion in  them  will  speedily  lead  to  a  similar  state  of  the  lungs  ; 
and  when  this  plethoric  condition  of  the  abdominal  and  pulmonary 
circulation  exists  in  a  considerable  degree,  either  hemorrhage  from 
the  bowels,  or  lungs,  or  apoplexy,  or  inflammation  of  some  impor- 
tant organ,  can  scarcely  fail  to  be  the  consequence.  This,  accord- 
ingly, is  the  manner  in  which  such  patients  are  often  suddenly 
carried  off.  In  these  cases,  therefore,  the  slightest  indication  of 
pulmonary  congestion  or  inflammation,  should  be  immediately 
attended  to. 

Artificial  climate. — In  place  of  sending  consumptive  patients  to 
pass  the  winter  in  a  foreign  climate,  it  has  been  proposed  to  keep 
them  at  home,  in  rooms  maintained  at  a  regulated  temperature. 
With  the  advocates  of  such  a  measure,  the  state  of  the  lungs  ap- 
pears to  be  the  only  consideration  ;  but,  without  improving  the 
general  health,  by  exercise  in  the  open  air,  all  our  measures, 
directed  to  the  local  disease,  will  be  of  little  avail — the  removal  of 
the  constitutional  disorder  can  alone  afford  the  patient  a  hope  of 


42  CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

recovery.  In  tuberculous  cachexy,  therefore,  and  even,  in  incipient 
stages  of  consumption,  particularly  in  young  persons,  I  consider 
such  a  measure  generally  most  inadvisable.  But,  in  the  advanced 
stages  of  consumption,  when  removal  to  a  distant  climate  is  worse 
than  useless,  life  may  be  prolonged,  in  many  cases,  by  keeping  the 
invalids  in  apartments,  the  temperature  of  which  is  regulated,  and 
the  air  maintained  in  a  pure  state.  Females  will,  cceteris  paribiiSj 
bear  such  a  system  of  confinement  better  than  males,  from  the  cir- 
cumstance of  its  being  more  congenial  to  their  usual  habits  of  life. 

In  cases  of  inflammation  of  the  lungs  occurring  during  the  win- 
ter, in  persons  predisposed  to  consumption,  keeping  the  patient 
entirely  to  the  house,  in  a  regulated  temperature,  till  all  symptoms 
of  the  disease  have  ceased,  or  even  until  the  return  of  mild  wea- 
ther, will  often  be  very  judicious.  But  when  a  person  so  circum- 
stanced has  the  means,  he  should  pass  the  following  winter  in  a 
climate  where  confinement  will  be  unnecessary,  and  where  he  can 
improve  his  general  health  by  exercise  in  the  open  air. 

Comparing,  then,  the  benefits  to  consumptive  patients,  likely  to 
be  derived  from  a  mild  climate,  and  confinement  to  rooms  regu- 
lated to  an  agreeable  temperature,  there  can  be  no  question  of  the 
decided  superiority  of  the  former.  But  when  circumstances  pre- 
clude the  possibility  of  changing  the  climate,  and  the  patient  is 
found  quite  unfit  to  bear  exposure  to  the  external  air  in  this  coun- 
try, then  confinement  to  apartments,  properly  and  equably  heated, 
is  the  best  measure  we  can  adopt  to  avoid  the  injurious  effects  of 
our  cold,  damp,  and  variable  atmosphere,  during  the  severe  season. 

Various  plans  have  been  tried  for  keeping  up  a  uniform  tempera- 
ture, and  at  the  same  time  preserving  the  air  in  a  state  of  purity, 
but  hitherto  with  very  imperfect  success.  The  common  fire-place 
is  the  worst  of  all  means,  and  strong  objections  attach  to  almost 
every  other  in  use.  The  self-regulating  stove,  invented  by  Dr. 
Arnott,  secures  an  equable  temperature  both  night  and  day,  at  a 
minimum  expenditure  of  fuel  and  trouble,  The  objection  brought 
against  it,  in  common  with  all  other  close  stoves,  that  the  apart- 
ments cannot  be  at  the  same  time  properly  ventilated,  can  have 
arisen  only  from  inattention  on  the  part  of  the  objectors  to  that 
portion  of  Dr.  Arnott's  work  which  treats  of  ventilating,  and  in 
which  effectual  means  are  described  for  securing  this  important 
purpose,  not  only  in  connection  with  the  stove,  but  generally. 

When  means  are  adopted  for  insuring  the  escape  of  the  impure 
air  from  the  upper  parts  of  the  room,  the  ventilation  may  be  made 
much  more  perfect  with  Dr.  Arnott's  stove  than  with  a  common 
fire. 

But  it  is  scarcely  possible  to  maintain  a  steady  temperature  in 
one  or  two  apartments,  the  doors  of  which  have  to  be  frequently 
opened,  unless  the  air  of  the  whole  house  is  warmed  on  its  first 
entrance.  This  may  be  effected  by  having  a  self-regulating  stove 
in  the  lobby  or  entrance  hall,  through  which  the  principal  supply  of 


PULMONARY  CONSUMPTION.  43 

air  passes.  An  additional  reason  for  maintaining  the  air  through- 
out the  house  at  a  certain  degree  of  warmth,  is,  that  it  enables  the 
invalid  to  leave  his  apartments  without  experiencing  any  material 
change  of  temperature  in  the  stairs  or  lobbies. 

In  addition  to  any  particular  arrangement,  for  keeping  up  a 
constant  ventilation,  it  would  be  of  great  advantage  to  have  the 
windows  completely  thrown  open  for  a  few  minutes  every  day, 
when  the  invalid  leaves  his  room,  in  order  that  the  air  throughout 
the  whole  apartment  may  be  completely  renewed.  The  walls  being 
always  warm,  the  cold  air  admitted  will  very  soon  be  raised  to  the' 
proper  temperature. 

By  thus  securing  purity  as  well  as  warmth  of  the  air,  not  only 
in  the  rooms  occupied  by  the  invalid,  but  throughout  the  whole 
building,  the  injurious  effects  which  would  result  to  the  constitution 
from  passing  the  winter  within  doors,  may  be  in  a  great  measure 
obviated,  and  the  utmost  advantages  which  can  accrue  from  it 
secured. 

The  invalid  who  has  passed  some  months  in  an  artificial  climate, 
established  within  doors,  should,  previously  to  his  first  going  out 
inro  the  open  air,  habituate  himself  to  changes  in  the  degree  of 
temperature  in  his  apartments  ;  and  when  he  does  venture  out  it 
should  be  with  proper  precautions. 

The  respirator  will  prove  a  valuable  protection  to  him  in  the 
first  instance,  and  for  some  time  afterwards,  on  any  sudden  or  con- 
siderable fall  of  temperature,  Indeed,  the  habitual  use  of  this 
instrument  may,  in  some  cases,  be  made  a  substitute  for  climate.1 
By  maintaining  in  their  houses  a  uniform  and  comfortable  degree 
of  warmth,  both  night  and  day,  and  by  the  use  of  the  respirator  out 
of  doors,  many  persons  who  labour  under  chronic  bronchial  disease 
might  escape  the  great  aggravation  of  it,  which  never  fails  to  dis- 
tress them  every  winter.  Those  who  dislike  the  appearance  of  the 
metallic  respirator  may  contrive  one  for  themselves,  of  a  less  formal 
appearance. 

By  keeping  up  the  habit  of  going  daily  into  the  open  air,  in 
almost  all  weathers,  under  the  protection  of  warm  clothing,  and,  in 
certain  cases,  with  the  additional  assistance  of  a  respirator,  during 
the  prevalence  of  cold  winds,  persons  with  very  delicate  lungs  may 
bring  themselves  to  bear  this  climate,  and  even  strengthen  their 
constitution  to  an  extent  not  generally  believed.  If,  in  addition  to 
this  daily  exposure  to  the  open  air,  for  a  longer  or  shorter  period, 
according  to  the  state  of  the  weather,  the  temperature  of  our  houses 
were  better  regulated,  we  should  meet  with  much  fewer  examples 
of  pulmonary  and  other  diseases,  generally  attributed  to  the  vicis- 
situdes of  our  climate,  but  for  which  we  are  more  indebted  to  the 
alternations  of  temperature  created  by  ourselves,  and  trie  neglect 

1  Mr.  Jeffrey  has  brought  his  respirator  to  a  state  of  great  neatness  ;  and 
has  reduced  the  price  to  the  lowest  rate,  in  order  that  the  poor  may  avail 
themselves  of  it. 


44  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

of  those  precautions  and  means  of  defence  which  are  within  our 
power.1 

>•.'•-: 


DISEASES  OF  THE  LARYNX,  TRACHEA,  AND  BRONCHI. 

In  no  class  of  complaints,  is  the  beneficial  action  of  change  of  air 
and  climate  more  speedily  manifested,  than  in  irritations  of  the 
organs  of  respiration.  In  the  slighter  bronchial  affections,  a  change 
to  a  very  short  distance  only,  has  often  a  remarkable  effect ;  coughs 
ceasing  in  the  course  of  a  few  days,  which  had  resisted  medical 
treatment  for  many  weeks.  But  in  protracted  cases  the  disease 
assumes  a  more  fixed  character,  and  requires  a  thorough  change 
of  climate  to  produce  much  effect  upon  it. 

Some  previous  treatment  will  generally  be  necessary  to  prepare 
the  patient  for  deriving  full  advantage  from  such  a  change ;  and 
he  should  be  made  acquainted  with  the  various  causes  likely  to 
increase  his  disease  while  traveling.  The  long  continuance  of  the 
disease  is  no  reason  for  disregarding  these  precautions,  as  chronic 
inflammation  may  be  easily  excited  during  a  journey  into  an  acute 
form. 

The  next  circumstance  which  requires  attention  in  bronchial 
diseases,  is  the  state  of  the  digestive  organs.  Irritation  of  the  lungs, 
more  especially  after  the  middle  period  of  life,  is  very  often  a  sym- 
pathetic affection,  depending  upon  irritation  of  the  stomach  and 
duodenum  and  congestion  of  the  liver.  Accordingly,  on  tracing 
the  progress  of  chronic  bronchial  diseases,  we  shall  generally  find 
that  they  were  preceded  for  some  time  by  a  disordered  state  of  the 
digestive  organs.  In  such  cases,  the  cure  depends  more  upon  the 
correction  of  the  primary  disorder,  than  upon  the  direct  influence 
of  climate  on  the  organs  of  respiration.  Indeed  the  chronic,  and 
even  the  acute  inflammations  of  the  chest,  are  comparatively  of 
easy  management  when  the  digestive  organs  are  in  a  state  of  in- 
tegrity— when  the  abdominal  circulation  is  unembarrassed,  and  the 
various  secretions  connected  with  digestion,  free  and  natural.2 

When,  therefore,  the  patient  is  suffering  from  dyspepsia,  this 
should  be  remedied,  as  far  as  possible,  before  he  leaves  his  own 
country;  otherwise  the  change,  so  far  from  proving  beneficial,  may 
be  injurious  to  him. 

The  skin  will  also  require  our  particular  attention,  as  it  is  seldom 
in  a  healthy  condition  in  persons  who  have  long  laboured  under 
bronchial  irritation. 

For  the  general  management  of  such  invalids  during  the  journey, 

1  For  some  excellent  advice  on  this  subject  I  refer  to  Dr.  Combe's  Prin- 
ciples of  Physiology  applied  to  the  Preservation  of  Health,  &c.,  chapter  vii., 
eighth  edition. 

2  For  some  very  judicious  remarks  on  this  subject,  I  beg  to  refer  to  the 
notes  on  the  article  Pneumonia,  in  Dr.  Forbes'  translation  of  Laennec. 


DISEASES  OF  THE  LARYNX,  TRACHEA,  AND  BRONCHI.          45 

I  beg  to  refer  to  the  article  on  that  subject,  at  the  commencement 
of  the  second  part  of  this  work ;  and  to  the  article  on  "  Disorders 
of  the  Digestive  Organs,"  for  directions  respecting  regimen;  as 
these  are  strictly  applicable  to  the  class  of  diseases  now  under  con- 
sideration. One  remedy,  however,  namely,  warm  bathing,  which 
is  highly  useful  in  dyspeptic  complaints,  requires  to  be  employed 
with  much  caution  in  bronchial,  and  still  more  in  tracheal  and 
laryngeal  irritations ;  and,  unless  by  medical  advice,  it  had  perhaps 
better  be  omitted  altogether  in  these  cases  during  the  journey. 

Besides  these  important  considerations,  which  the  physician  alone 
can  regulate,  there  are  some  minor  circumstances  which  claim  the 
attention  of  the  patient;  and  respecting  which  he  can  minister  to 
himself.  Persons  labouring  under  irritation  of  the  respiratory  organs 
should  be  particularly  careful  during  the  journey,  and,  indeed,  at 
all  times  and  in  all  climates,  to  avoid  currents  of  air.  Although  it 
is  important  that  they  should  take  daily  exercise  in  the  open  air, 
when  the  weather  is  favourable,  it  is  far  better  to  remain  for  a  few 
days  within  doors,  than  to  expose  themselves  to  a  cold  and  humid 
atmosphere,  or  to  cold  winds. 

To  persons  suffering  from  bronchial  irritation,  or  who  are  very 
liable  to  that  complaint,  the  application  of  cold  water,  or  salt,  or 
vinegar  and  water,  to  the  chest  and  neck  every  morning,  followed 
by  active  friction,  is  very  useful.  This  practice  might  be  generally 
adopted,  with  great  advantage,  at  all  seasons  in  this  country,  where 
colds  and  inflammatory  sore  throats  are  among  the  most  prevalent 
complaints.1 

By  means  of  cold  sponging  or  the  shower  bath,  and  friction,  and 
the  occasional  use  of  the  warm  bath,  with  a  steady  perseverance 
in  a  mild  regimen  and  regular  exercise,  particularly  on  horseback, 
a  surprising  change  may  often  be  effected  in  the  health  and  feelings 
of  delicate  persons,  and  their  sensibility  to  cold  greatly  diminished. 

Warm  clothing  is  particularly  necessary,  and  flannel  next  the 
skin,  during  the  day,  I  consider  indispensable.  When  the  trachea 
is  the  seat  of  the  affection,  the  neck  and  upper  part  of  the  chest 
should  be  particularly  well  covered,  during  the  winter  and  spring, 
with  flannel  or  chamois  leather.  The  lower  extremities  should 
be  kept  warm;  arid  I  wish  it  to  be  understood,  that  these  precau- 
tions are  as  necessary  in  the  south  of  Europe  as  in  this  country  : 
for,  although  in  the  former  the  weather  is  altogether  considerably 
warmer  and  drier,  and  the  winter  much  shorter,  than  in  England, 
the  alternations  of  temperature  are  quite  as  great,  while  the  houses 
are  colder.  The  spring,  too,  in  the  south  of  Europe,  is  very  irritat- 

iuln  ray  own  experience,"  says  Dr.  Forbes,  "the  effect  of  sponging  the 
chest  with  cold  water  and  vinegar  once  or  twice  a  day  has  proved  of  im- 
mense benefit  to  delicate  subjects,  and  more  especially  to  those  liable  to 
catarrhal  affections,  and  to  persons  decidedly  phthisical.  In  these  cases, 
although  no  doubt  the  practice  proves  tonic  to  the  system  generally,  I  con- 
ceive its  chief  operation  is  in  lessening  the  sensibility  of  the  lungs  to  the 
impression  of  cold."—  Translation  of  Laennec,  3d  Edit.  p.  98. 


46  CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

ing;  and  hence,  during  that  season,  the  greatest  circumspection  is 
required,  on  the  part  of  the  class  of  invalids  for  whom  I  am  now 
writing. 

With  respect  to  the  best  winter  residence,  I  found  Rome  agree 
more  decidedly  with  such  patients  than  any  other  place  on  the  Con- 
tinent ;  and  I  repeatedly  had  occasion  to  compare  its  influence  with 
that  of  the  other  climates  upon  the  same  patients.  The  climate  of 
Rome  is  not,  however,  so  beneficial  when  the  disease  is  accompanied 
with  copious  expectoration,  and  a  relaxed  state  of  the  system,  as 
that  of  Nice  ;  but  in  the  dry  tracheal  and  bronchial  affections,  the 
climate  of  Rome,  and  also  that  of  Pisa,  is  preferable.  Rome  has 
several  obvious  advantages  over  the  other  residences  on  the  Conti- 
nent, for  patients  labouring  under  bronchial  irritation.  It  is  little 
liable,  to  high  winds,  the  air  is  soft,  and  the  surrounding  country 
well  adapted  for  riding, — the  best  exercise  for  such  patients. 

But  at  Rome,  the  invalid  labouring  under  bronchial  disease  will 
find  reason  for  much  self-denial.  He  must  be  cautious  in  his  visits 
to  the  cold  galleries  and  churches,  and  to  such  of  the  ancient  ruins 
as  are  damp,  or  subject  to  currents  of  air,  else  he  will  run  the  risk 
of  repeated  relapses.  During  a  strong  northerly  wind  he  should 
not  stir  out  of  doors.  I  have  known  a  single  ride,  during  the  preva- 
lence of  this  wind,  produce  a  renewal  of  the  disease  in  a  patient 
who  had  been  steadily  improving  for  several  months. 

With  the  exception  of  cases  in  which  there  is  a  copious  expecto- 
ration, and  a  relaxed  state  of  the  system,  the  climate  of  Madeira 
proves  very  beneficial,  and  is  preferable  to  any  part  of  the  Conti- 
nent. In  this  country,  Torquay  is  the  best  climate  in  the  dry 
bronchial  irritations;  for  those  with  copious  expectoration,  a  relaxed 
condition  of  the  system,  or  an  atonic  state  of  the  digestive  organs, 
UnderclifTand  Clifton  afford  better  climates.  Invalids  of  this  class 
may  derive  great  benefit  from  a  well  directed  tour  during  the  sum- 
mer, or  rather  frequent  changes  of  air  and  place  ;  for  this  is  much 
more  beneficial  to  them,  more  particularly  if  females,  than  a  con- 
tinuous journey.  Traveling  rapidly  seldom  fails  to  derange  the 
system  in  some  degree,  and  this  will  in  a  great  measure  be  coun- 
teracted by  short  journeys,  and  resting  at  different  places  a  week  or 
ten  days ;  at  the  same  time,  to  be  effectual,  the  tour  should  extend 
over  a  considerable  extent  of  country,  and  all  those  precautions 
which  have  been  suggested  as  necessary  on  a  journey  ought  to  be 
attended  to. 

It  is  scarcely  necessary,  after  what  has  been  said  on  diseases  of 
the  mucous  membrane  of  the  digestive  and  respiratory  organs,  to 
enter  on  the  subject  of  similar  diseases  of  the  mucous  surfaces  of 
other  parts.  It  may  suffice  to  observe,  that  in  chronic  irritation  of 
all  these  membranes,  a  mild  climate  will  generally  prove  beneficial. 


ASTHMA.  47 


ASTHMA. 

Asthma  is  a  term  applied  in  common  language,  to  various  diseases 
in  which  difficulty  of  breathing  is  a  prominent  symptom.  In  tech- 
nical language  it  implies  a  disease  in  which  the  difficulty  of  breath- 
ing occurs  in  paroxysms.  Asthma  is  very  often  sympathetic  of  a 
morbid  state  of  some  other  important  organ,  as  the  heart,  the  diges- 
tive organs  the  womb,  &c.  Before  recommending  climate,  or  any 
other  remedy,  to  an  asthmatic  patient,  therefore,  the  state  of  these 
organs  ought  to  be  carefully  enquired  into.  In  almost  all  cases  of 
asthma,  the  digestive  organs  are  disordered.  The  skin  is  also  very 
often  dry,  harsh,  and  not  un frequently  affected  with  eruptions.  The 
connection  between  the  morbid  state  of  the  skin  and  this  disease  is 
rendered  very  evident,  in  some  cases,  by  the  first  attack  of  asthma 
succeeding  to,  and  apparently  depending  upon,  the  disappearance 
of  some  cutaneous  complaint,  which  had  been  injudiciously  removed 
by  local  applications,  while  the  cause  of  it  was  neglected :  this  I 
have  known  to  occur  at  the  early  age  of  five  years. 

In  no  disease,  perhaps,  is  the  effect  of  change  of  climate  so  con- 
spicuous as  in  asthma.  Taking  the  disease  generally,  it  may  be 
stated,  that  a  removal  to  a  warmer  climate  is  highly  beneficial;  but 
the  degree  of  relief  will  depend  greatly  upon  the  climate  being 
suited  to  the  particular  case.  We  must  not,  therefore,  prescribe  for 
a  name,  but  take  into  account  the  whole  pathological  condition  of 
the  patient,  in  order  that  we  may  be  enabled  to  fix  upon  the  climate 
best  suited  to  his  case. 

The  following  forms  of  asthma  require  attention,  in  prescribing 
change  of  air  or  climate. 

Pure  Nervous  Asthma. — It  is  difficult  to  say  what  place  will 
agree  best  with  this  form  of  asthma.  The  general  constitution  of 
the  patient,  and  his  past  experience  in  the  particular  quality  of  air 
which  suits  him,  will  assist  us  in  deciding.  This  form  of  the 
disease  is  comparatively  very  rare,  and  I  did  not  see  a  sufficient 
number  of  cases  while  abroad  to  enable  me  to  state  any  thing  very 
positive  respecting  the  influence  of  particular  climates  on  it.  What 
very  often  passes  for  simple  spasmodic  asthma  will  be  found,  on 
closer  examination,  to  be  complicated  with  that  diseased  state  of  the 
mucous  membrane  of  the  lungs,  termed  dry  catarrh,  an  affection 
which  generally  remains  latent  for  a  considerable  time,  and  is  very 
often  overlooked  ;  nevertheless  it  is  a  very  frequent  cause  of  asthma. 
In  this  form  of  disease,  the  climate  of  Rome  will  generally  be  found 
to  a^ree  well. 

Humid  Asthma. — This  variety  is  asthma  complicated  with 
chronic  bronchitis,  and  is  one  of  the  most  common  forms  of  the 
disease.  It  may  be  either  idiopathic,  or  symptomatic  of  disordered 
digestive  organs;  in  the  former  case,  it  is  commonly  much  bene- 
fited by  the  climate  of  Nice ;  which  is  also  often  useful  in  the 
latter  variety,  although  the  amount  of  benefit  will  depend  on  the 


48  CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

kind  and  degree  of  the  gastric  affection  of  which  the  asthma  is 
symptomatic.  On  this  subject  I  need  not  repeat  what  has  been 
already  said  in  the  articles  on  dyspepsia  and  bronchial  diseases. 

Cardiac  Asthma. — Asthma  dependent  upon,  or  complicated  with 
disease  of  the  heart,  may  receive  temporary  relief  from  a  mild 
climate ;  but  the  nature  of  the  primary  disease  demands  the  chief 
consideration,  as  upon  our  power  of  abating  it,  must  mainly  depend 
our  hopes  of  any  permanent  effect  being  produced  on  the  asthma. 
When  change  of  climate  is  adopted,  in  this  complication,  a  voyage 
is  preferable  to  a  land  journey. 

In  asthma  complicated  with  chronic  irritation  of  the  bronchial 
membrane,  or  of  the  digestive  organs,  or  with  a  congestive  state  of 
the  hepatic  system,  or  an  unhealthy  condition  of  the  skin,  a  course 
of  warm  mineral  water  will  prove  of  much  benefit. 


GOUT. 

In  the  early  stages  of  this  disease,  if  the  patient  possesses  sufficient 
resolution  to  adhere  to  a  regimen  calculated  to  remove  the  gouty 
disposition  entirely,  a  residence  for  some  time  in  a  rnild  climate 
will  greatly  favour  his  endeavours. 

In  confirmed  cases,  when  the  joints  are  permanently  affected,  and 
when  serious  inroads  have  been  made  on  the  constitution,  a  mild 
climate  very  often  improves  the  state  of  the  general  health,  and 
prolongs  the  interval  between  the  paroxysms. 

The  regimen  of  the  gouty  invalid,  residing  in  the  south  of  Eu- 
rope, while  it  requires  to  be  regulated  according  to  the  circum- 
stances of  the  individual  case,  should  also  be  adapted  to  the  climate. 
If  the  disease  is  in  an  early  stage,  and  a  cure  is  expected,  a  very 
mild  regimen  is  necessary;  and,  as  a  part  of  this,  total  abstinence 
from  wine.  In  the  chronic  form  of  the  disease,  the  previous  habits 
of  the  patient  must  be  taken  into  consideration,  in  regulating  his 
regimen.  A  mild  diet  will,  however,  be  more  necessary  in  Italy 
than  in  England.  Sweet  acid  wines,  should  be  avoided ;  but  the 
sound  French  wines,  especially  those  of  Bourdeaux,  will  soon  be 
found  to  agree  with  the  generality  of  such  invalids  ;  and,  contrary 
to  the  general  belief,  prove  less  "gouty,"  and  less  injurious  to  the 
health,  than  the  more  spirituous  wines  of  Spain,  Portugal,  and 
Sicily:  abstinence  from  all  kinds  of  wine  is  still  better;  and  might, 
I  believe,  be  often  successfully  adopted  even  in  cases  of  gout  of 
long  standing. 

Warm  mineral  waters,  employed  both  internally  and  externally, 
prove  very  beneficial  in  chronic  gout,  and  are  well  calculated,  in 
many  cases,  to  improve  the  general  health,  and  restore  the  tone  of 
the  affected  parts.1 

1  See  Appendix  on  Mineral  Waters. 


DELICACY    IN    CHILDHOOD   AND    YOUTH.  49 


CHRONIC  RHEUMATISM. 

A  residence  for  some  time  in  a  mild  climate  proves  of  the  greatest 
benefit  in  chronic  rheumatism.  Nice  and  Rome  are  the  best  cli- 
mates on  the  Continent,  according  to  my  experience.  Rheumatism 
is  very  often  complicated  with  and  kept  up  by  a  disordered  state 
of  the  digestive  organs,  without  the  removal  of  which  the  affection 
of  the  joints  can  scarcely  be  cured.  In  cases  of  this  nature,  when 
gastritic  irritation  exists,  Rome  is  the  better  climate ;  while,  in  the 
pure  chronic  rheumatism,  Nice  deserves  the  preference, — as  it  does 
also  in  those  complicated  forms  of  rheumatism,  in  which  the  disease 
exists  in  combination  with  an  atonic  or  relaxed  state  of  the  stomach. 
In  cachectic  rheumatism,  or  that  chronic  affection  of  the  joints  de- 
pendent upon  a  cachectic  state  of  the  system,  and  when  the  disease 
is  complicated  with  anomalous  eruptions,  Nice  has  also  appeared  to 
agree  well. 

When  a  winter  passed  in  Italy  fails  to  remove  the  rheumatism,  I 
would  recommend  a  course  of  some  of  the  mineral  waters  on  the 
Continent,  known  to  be  most  beneficial  in  such  cases. 


DELICACY  IN  CHILDHOOD  AND  YOUTH. 

There  are  two  periods  in  early  life,  when  a  residence  for  some 
time  in  the  south  of  Europe  has  appeared  to  me  particularly  useful. 

The  first  is  during  childhood,  from  about  the  third  or  fourth  year 
upwards.  At  this  age  children  often  become  delicate  and  subject 
to  catarrh  on  slight  exposure  to  cold,  to  gastritic  irritation,  consti- 
pated bowels,  swelling  of  the  lymphatic  glands,  and  other  symp- 
toms indicating  a  strumous  disposition.  In  such  cases  a  temporary 
residence  in  a  warm  climate  proves  very  beneficial.  During  my 
residence  in  the  south  of  Europe,  I  found  the  health  of  delicate 
English  children,  whether  of  a  strumous  habit  or  otherwise,  very 
much  improved  by  one  or  more  winters  in  Italy.  The  mildness 
and  dryness  of  the  Italian  winter,  and,  still  more,  its  shortness, 
compared  to  that  of  this  country,  sufficiently  explain  the  beneficial 
effects  produced  on  the  little  invalids.  Their  delicate  frames  are 
not  chilled  so  much,  nor  for  so  long  a  period  of  the  year,  as  in  our 
own  climate,  while  they  are  enabled  to  be  much  more  in  the  open 
air ;  a  circumstance  of  the  greatest  importance  to  delicate  children, 
and  for  the  want  of  which  nothing  can  compensate.  I  must  here, 
however,  restrict  my  praise  to  winter  alone,  as  the  summer  in  Italy 
has  often  an  injurious  effect  upon  such  children,  especially  if  the 
residence  is  prolonged  beyond  a  single  season.1 

1  The  winter  in  Italy  proves  useful  in  difficult  dentition,  but  summer  is,  in 
the  same  degree,  pernicious.  Infants  in  Italy  should  generally  be  suckled 
for  a  longer  period  than  in  England;  and  it  is  a  rule  never  to  wean  them  in 
the  spring  while  teething. 

1— d  4  dark 


50  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

Rome  and  Nice  are,  according  to  my  observation,  the  best  winter 
residences  for  children.  The  general  characters  of  their  climates, 
and  the  opportunities  which  the  surrounding  country  affords  for 
exercise,  give  these  places  a  superiority  over  other  towns  resorted 
to  by  strangers  in  Italy.  When  the  digestive  organs  are  in  an  irri- 
table state,  Rome  will  be  the  more  suitable  residence.  On  the  other 
hand,  if  there  is  a  torpid,  languid  state  of  the  constitution,  Nice 
affords  a  preferable  climate. 

Children  subject  to  chronic  croup  will  derive  advantage  from  a 
winter  passed  in  Italy ;  for  although  this  disease  is  generally  con- 
nected with  a  disordered  state  of  the  digestive  organs,  it  is  often 
induced  by  exposure  to  cold  and  damp,  in  children  predisposed  to 
it.  Croup  is  scarcely  known  in  southern  Italy;  and  among  child- 
ren who  had  previously  had  the  disease,  no  relapses,  1  believe, 
occurred  during  my  residence  at  Rome. 

When  there  is  a  disposition  to  hydrocephalus  (comparatively  a 
rare  disease,  I  think,  in  the  south  of  Europe,)  and  when  there  is 
not  much  gastritic  irritation,  the  same  change  of  climate  will  be 
useful. 

But  by  far  the  most  important  disease  of  childhood,  and  that 
which,  when  rightly  understood,  forms  the  key  to  the  treatment  ot 
almost  all  diseases  occurring  at  this  period  of  life,  is  a  disordered 
state  of  the  digestive  organs.  This  subject  is,  in  my  opinion,  so 
important  and  so  intimately  connected  with  the  design  of  the  present 
work,  that  I  deem  no  apology  necessary  for  entering  at  some  length 
into  it. 

Dyspepsia  in  Children. — A  deranged  state  of  the  digestive  organs 
is  the  source  of  most  of  the  chronic,  while  it  aggravates,  and  in- 
creases the  danger  from  all  the  acute  diseases  to  which  childhood 
is  liable,  such  as  hooping-cough,  measles  and  scarlatina.  If  ne- 
glected, it  also  leads  to  an  unhealthy  youth,  and  imperfect  develop- 
ment of  the  body ;  but  above  all,  it  is  the  principal  cause  of  that 
morbid  state  of  the  system  which  has  been  denominated  tuberculous 
cachexy.  In  the  hygeienic  management  of  children,  therefore,  it  is 
of  the  utmost  importance  that  correct  views  should  be  entertained 
respecting  the  nature  and  causes  of  disorders  of  the  digestive 
organs. 

Dyspepsia  may  assume  the  same  characters  in  childhood  as  in 
the  more  advanced  periods  of  life,  but  by  much  the  most  frequent 
and  destructive  form  of  the  disease  is  that  which  has  been  named 
by  medical  writers  Strumous  Dyspepsia^  from  its  being  intimately 
connected  with  scrofula  in  all  its  forms.1 

The  symptoms  in  the  early  stages  vary  much  in  degree  in  child- 
ren of  different  constitutions.  When  not  well  marked  they  may 

1  Strumous  Dyspepsia  has  been  admirably  described  by  my  late  lamented 
and  talented  friend  Dr.  Todd,  in  his  able  article  on  Indigestion,  in  the  Cyclo- 
paedia of  Practical  Medicine.  To  that  article  I  beg  to  refer  the  medical 
reader  for  a  full  account  of  dyspepsia  in  all  its  forms. 


DELICACY  IN  CHILDHOOD  AND  YOUTH.  51 

exist  a  considerable  time  without  attracting  much  notice.  The 
child  is  thirsty,  feverish  and  restless  in  the  early  part  of  the  night, 
and  towards  morning  often  becomes  bathed  in  copious  perspirations. 
The  tongue  is  generally  florid,  and  towards  the  point  the  papillae 
are  prominent  and  red.  The  appetite  is  variable ;  the  bowels  costive, 
and  the  motions  generally  pale  ;  the  urine  is  high-coloured  or  turbid. 
As  the  disease  advances,  the  tongue  becomes  more  loaded,  the  breath 
fetid,  the  countenance  loses  its  natural  colour  and  animated  expres- 
sion ;  the  child  looks  pale  and  pasty,  and  the  flesh  is  soft ;  the 
appetite  is  at  times  craving,  and  at  other  times  there  is  no  desire  for 
food.  If  the  little  patient  be  neglected  or  improperly  treated,  the 
skin  becomes  harsh  and  dry,  the  abdomen  tumid,  the  extremities 
waste,  the  eyelids  are  swollen  and  inflamed,  and  puriform  discharges 
occur  from  the  ears ;  the  glands  of  the  neck  become  enlarged, 
and  cutaneous  eruptions  not  unfrequently  appear.  The  child  is 
now  on  the  verge  of  tuberculous  cachexy,  into  which  he  soon  lapses 
unless  judiciously  treated.  Dr.  Todd  is  of  opinion,  that  this  form 
of  dyspepsia  is  more  characteristic  of  the  strumous  or  tuberculous 
disposition  than  any  of  the  external  signs  which  have  been  usually 
trusted  to  as  its  indications. 

A  change  to  a  mild  climate  under  such  circumstances  will  be  of 
the  utmost  advantage  to  the  child.  During  summer,  frequent 
changes  of  air  will  be  productive  of  great  benefit.  In  the  early 
part  of  the  summer,  the  interior, — and  towards  the  end,  and  during 
the  autumn,  the  sea-side  will  best  suit  such  children.  But  no 
general  measure  of  this  kind  should  be  adopted,  till  the  morbid  state 
of  the  digestive  organs  is  in  some  degree  corrected  ;  and  wherever 
a  child  goes,  this  should  receive  constant  attention.  For  although 
the  general  health  may  be  much  improved  by  change  of  air,  or 
climate,  the  improvement  will  not  be  permanent  unless  the  conges- 
tion and  irritation  of  the  digestive  organs,  in  which  the  disorder 
had  its  origin,  and  on  which  its  continuance  depends,  are  removed. 
With  this  view  every  means  calculated  to  correct  this  state  should 
be  adopted.  The  most  important  is  the  regulation  of  the  diet. 
This  must  of  course  be  varied  according  to  the  age  of  the  child, 
and  the  degree  of  congestion  and  irritation  which  exists.  Gene- 
rally speaking,  the  diet  should  be  of  the  blandest  quality,  more 
especially  in  children  of  an  excitable  constitution.  When  the 
tongue  is  red,  the  skin  hot  at  night,  with  thirst,  milk  and  farinaceous 
food  should  constitute  almost  the  sole  nourishment.  As  the  irrita- 
tion abates,  a  little  mild  animal  food  every  second  day  is  allowable. 
For  children  of  a  more  torpid  character  of  constitution,  who  have 
little  disposition  to  fever,  when  the  tongue  is  loaded,  and  all  the 
functions  languid,  a  more  exciting;  diet  may  be  permitted.  The 
warm  bath  and  friction  will  be  beneficial  in  all  cases,  more  especially 
in  the  languid  constitutions  just  alluded  to.  The  great  objects  in 
the  treatment  should  be,  to  regulate  the  diet,  according  to  the  sensi- 
bility and  power  of  the  digestive  organs,  to  promote  an  active  state 
of  circulation  in  the  surface  and  extremities,  with  a  view  to  remove 

4* 


52  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

the  congestion  and  irritation  of  the  internal  organs,  and  to  impart 
tone  to  the  system.  Without  removing  the  morbid  state  of  the 
duodenum,  and  the  congestion  of  the  liver  and  abdominal  organs 
generally,  it  will  be  in  vain  to  expect  a  free  state  of  the  circulation, 
in  the  surface  and  extremities,  a  healthy  condition  of  the  skin,  or 
the  power  of  resisting  cold.  This  irritation  of  the  digestive  organs 
influences  every  function  of  the  body,  and  without  its  removal,  all 
remedies  directed  to  the  improvement  of  the  general  health  will 
produce  only  a  partial  and  evanescent  effect. 

This  is  not  the  place  to  discuss  the  medical  treatment,  but  I  can- 
not resist  the  occasion  of  entering  my  caveat  against  the  inconsi- 
derate routine  practice  generally  adopted  in  such  cases.  Active 
mercurial  purgatives,  an  exciting  diet  of  animal  food,  not  unfre- 
quently  repeated  several  times  a  day,  with  the  addition  of  porter  or 
wine,  or  both  ;  and  this  followed  by  steel  and  other  tonics,  constitute 
generally,  in  this  country,  the  treatment  of  scrofulous  children. 
Such  a  mode  of  treatment  is  at  total  variance  with  the  gastro-duo- 
denal  irritation  and  hepatic  congestion,  which  are  present  in  a 
greater  or  less  degree  in  all  cases  of  scrofula.  Besides  this,  com- 
plete want  of  success  attends  it  in  practice,  whilst  striking  benefit 
is  derived  from  an  opposite  plan  of  treatment. 

When  change  to  a  distant  climate  can  not  be  accomplished,  a  resi- 
dence in  some  of  the  milder  situations  in  our  own  island  will  often 
be  of  great  service  in  improving  the  health  of  delicate  children. 
The  sea-coast  is  considered  the  best  residence  for  scrofulous  child- 
ren, and  delicate  young  persons  generally.  This  opinion,  however, 
is  not  always  correct ;  and  even  when  sea-air  is  desirable,  it  is  not 
a  matter  of  indifference  what  situation  is  chosen.  There  is  a  con- 
siderable variety  in  the  climate  of  the  different  places  on  the  sea- 
coast  resorted  to  by  invalids.1  For  some  cases  of  scrofula,  a  dry, 
bracing  air,  such  as  that  of  Brighton,  will  be  the  most  suitable ;  for 
others,  the  more  sheltered  situations  of  Undercliff  or  Hastings  ;  and 
the  mild  and  soft  climate  of  the  south-coast  of  Devon  will,  in  many 
cases,  prove  a  very  favourable  winter  residence  ;  whilst  during'ihe 
summer  months,  a  dry  elevated  part  of  the  interior,  such  as  that 
afforded  by  the  Malvern  Hills,  will  often  be  superior  to  any  part  of 
the  sea-coast. 

The  second  period  of  youth  at  which  I  consider  a  mild  climate 
more  decidedly  beneficial,  is  about  puberty.  It  frequently  happens, 
at  this  age,  that  from  pursuing  a  course  of  study  too  assiduously, 
especially  during  the  debility  consequent  upon  rapid  growth,  or 
from  various  other  causes,  the  health  is  materially  injured  ;  the 
whole  system  is  debilitated,  and  the  changes  which  take  place  at 
this  period  of  life,  either  do  not  appear,  or  do  so  imperfectly,  and 
the  development  of  the  body  is  not  fully  accomplished.  The  young 
person  loses  his  usual  colour,  plumpness,  and  strength ;  the  face  is 
pale,  and  the  features  are  fallen ;  the  skin  dry  and  harsh,  or  relaxed 

1  See  article  on  Consumption. 


CLIMACTERIC    DISEASE.  53 

and  moist,  or  the  former  state  alternates  with  general  or  partial  per- 
spirations: cutaneous  eruptions  are  also  common  ;  the  feet  are  very 
liable  to  become  cold;  the  bowels  are  constipated;  the  tongue 
loaded,  and  the  digestive  organs  disordered.  The  nervous  system 
is  morbidly  sensitive,  and  the  temper  irritable,  or  there  is  great 
mental  depression,  and  the  whole  moral  character  is  often  remark- 
ably changed  :  there  is  an  indifference  to  the  objects  and  pursuits 
which  previously  interested  the  mind,  and  a  disinclination  for  either 
bodily  or  mental  exertion.  Tuberculous  disease  often  shows  itself 
under  such  circumstances,  for  the  first  time. 

One  of  the  most  powerful  means  of  preventing  such  disorders 
when  threatened,  and  of  removing  them  when  they  have  occurred, 
is  a  temporary  residence  in  a  warm  climate  :  and  when  the  person 
is  known  to  have  a  hereditary  predisposition  to  consumption,  the 
measure  is  more  urgently  called  for;  as  the  deranged  condition  of 
the  system,  if  not  soon  corrected,  may  terminate  in  the  constitutional 
disorder  which  we  have  seen  to  be  the  precursor  and  essential  cause 
of  consumption.  If  change  of  climate  cannot  be  accomplished, 
the  winter  should  be  passed  in  some  of  the  milder  parts  of  our  own 
island,  where  by  exercise  in  the  open  air,  warm  sea-bathing,  and  a 
well  regulated  diet,  much  may  be  done  to  rescue  the  youthful  in- 
valid from  the  impending  danger. 

Although  I  have  particularly  noted  early  childhood  and  puberty, 
as  the  periods  of  life  at  which  a  mild  climate  proves  signally  bene- 
ficial, there  is  no  period  of  youth  at  which  it  may  not  be  had 
recourse  to  with  advantage,  under  the  circumstances  pointed  out. 


CLIMACTERIC  DISEASE. 

We  have  just  seen  that  climate  may  be  made  available  for  the 
correction  and  removal  of  derangements  of  health,  occurring  in 
youth  and  impeding  the  development  of  the  body;  we  also  find 
that,  as  age  advances,  and  the  system  begins  to  feel  the  weight  of 
years,  climate  proves  highly  beneficial  in  arresting  premature 
decay. 

At  the  age  of  from  fifty  to  sixty,  sometimes  earlier,  a  remarkable 
change  often  takes  place  in  the  health,  without  any  very  obvious 
cause.  The  person's  appearance  becomes  greatly  altered ;  his 
strength  is  diminished,  and  he  generally  becomes  thin,  and  looks 
aged.  He  is  unequal  to  the  mental  and  bodily  exertions  to  which 
he  has  been  habituated ;  and  the  consciousness  of  this  frequently 
induces  a  depression  of  spirits  and  fretfulness  of  temper;  or  these 
may  exist  as  direct  effects  of  the  bodily  disorder.  With  the  more 
general  evidences  of  deteriorated  health,  some  organs  of  importance 
to  life,  most  frequently,  the  digestive  organs,  show  symptoms  of 
disorder.  An  habitual  morning  cough,  with  more  or  less  of  ex- 
pectoration, cutaneous  eruptions,  swellings,  and  pains  in  the  joints, 


54  CLARK  ON  THE  SANATIVE  INFLUENCE  ON  CLIMATE. 

or  nervous  affections,  chiefly  of  a  painful  kind,  amounting  even  to 
tic-douloureux,  often  precede  and  accompany  this  state :  or  the  in- 
dividual lapses  into  a  general  cachexy,  without  much  evident  local 
disease.  The  whole  system  is,  I  believe,  in  these  cases,  in  a  morbid 
condition.  If  such  a  person  is  attacked  with  any  acute  disease,  the 
constitution  may  sink  under  it  with  great  rapidity. 

This  state  constitutes  what  is  not  unaptly  termed  in  common 
language  "a  breaking  up  of  the  constitution;"  which,  in  truth,  it 
generally  proves  to  be,  if  not  judiciously  treated.1 

These  symptoms  of  premature  decay  originate  often  in  too  much 
mental  exertion,  close  attention  to  business,  and  its  consequent  cares 
and  anxieties  ;  frequently  they  are  the  effects  of  a  sedentary  life 
and  an  habitual  system  of  full  living ;  more  frequently  still,  they 
are  the  result  of  the  combined  influence  of  these  causes.  From 
whatever  cause  the  disorder  proceeds,  one  or  two  winters  passed  in 
a  warm  climate,  with  the  adoption  of  such  a  regimen,  and  the  use 
of  such  other  remedial  measures  as  the  particular  case  may  require, 
will  prove  of  essential  service  in  arresting  the  progress  of  decay, 
arid  restoring  the  invalid  to  a  state  of  better  health. 

Dr.  Warren,  of  Boston,  United  States,  informed  me,  that  he  had 
frequently  been  struck  with  the  beneficial  influence  which  a  visit 
to  Europe  had  in  renovating  the  health  of  his  countrymen  about 
the  middle  period  of  life,  when  the  constitution  had  begun  to  flag, 
from  application  to  business  and  the  cares  and  duties  of  life  :  and 
he  himself  experienced,  from  his  visit,  a  similar  improvement  in  his 
own  health. 

The  change  of  climate,  in  this  case,  is  no  doubt  a  very  complete 
one,  and  is  accompanied  with  all  those  favourable  circumstances 
which  contribute  so  much  to  aid  climate  in  the  restoration  to  health. 
Any  thing,  indeed,  more  likely  to  produce  a  favourable  change  in 
the  constitution,  and  call  forth  its  latent  energies,  than  a  visit  to 
Europe  by  a  citizen  of  the  United  States,  can  scarcely  be  imagined. 

When  a  change  of  climate  cannot  be  accomplished,  great  benefit 
may  be  obtained  from  a  change  of  air  in  our  own  country  ;  from 
the  use  of  warm  or  tepid  sea-bathing,  and  a  course  of  such  warm 
mineral  waters  as  are  suited  to  the  case.  But  to  derive  permanent 
benefit  from  these  measures,  the  invalid  must  henceforth  change  his 
mode  of  life,  and  eschew  those  causes  which  first  brought  him  into 
jeopardy. 

Persons  just  returned  to  Europe,  and  whose  constitutions  have 
suffered  by  a  long  residence  in  a  tropical  climate,  will  find  great 
advantage  in  spending  one  or  more  winters  in  the  south  of  Europe 
before  finally  settling  in  this  country.2  The  great  object  in  such 

1  See  an  excellent  paper  on  the  Climacteric  Disease,  by  Sir  Henry  Hal- 
ford,  Bart.,  President  of  the  Royal  College  of  Physicians.— Medical  Trans- 
actions, vol.  iv.  p.  316,  &c. 

2  For  some  very  judicious  advice  to  persons  returning  from  a  warm  climate, 
the  reader  is  referred  to  Dr.  James  Johnson's  Essay  on  Morbid  Sensibility 
of  the  Stomach  and  Bowels  as  the  Cause  of  Indigestion,  &c.     Tenth  edi- 
tion.    1840. 


CLIMACTERIC  DISEASE.  55 

cases  is  to  maintain  an  active  state  of  the  circulation  on  the  surface 
and  extremities,  by  warm  clothing,  exercise,  friction,  and  the  use 
of  the  warm  bath.  By  these  measures,  any  sudden  change  in  the 
relative  state  of  the  circulation  and  secretion  of  the  skin  and  in- 
ternal organs,  the  consequence  of  a  removal  from  a  hot  to  a  cold 
climate,  will  be  obviated,  and  pulmonary  and  hepatic  diseases  pre- 
vented.1 

Friction  in  particular  may  be  made  a  most  efficient  means  of 
promoting  an  active  state  of  the  cutaneous  circulation.  The  flesh- 
brush,  horse-hair  gloves,  or  flannel,  may  be  used,  according  to  the 
sensibility  of  the  skin ;  but  the  friction,  to  be  effectual,  should  be 
active,  and  applied  over  the  whole  surface,  particularly  the  extremi- 
ties. Sponging  the  chest  and  arms  every  morning  with  cold  water, 
will  also  aid  in  promoting  the  same  objects.  When  the  skin  is 
torpid  or  relaxed,  friction  may  be  advantageously  employed,  before 
the  cold  sponging  as  well  as  after  it. 

When  the  biliary  system  is  greatly  deranged,  a  frequent  occur- 
rence with  natives  of  this  country  who  have  passed  some  time  in 
India,  a  course  of  mineral  water  will  prove  very  useful,  particularly 
after  a  winter  spent  in  the  south  of  Europe.  Mineral  waters  are 
frequently  found  to  remove  what  are  commonly  called  biliary  symp- 
toms, indigestion,  low  spirits,  &c.,  by  restoring  a  regular  and  healthy 
action  of  the  liver,  of  the  bowels,  and  of  the  skin.2 

There  are  various  other  states  of  impaired  health,  in  which 
change  of  air  and  climate  prove  very  beneficial.  Indeed  it  would 
be  difficult  to  name  the  chronic  complaint,  or  the  disordered  state 
of  health,  which  would  not  admit  of  being  ameliorated  by  the  judi- 
cious adoption  of  such  a  measure. 

In  the  convalescence  from  fevers  and  other  acute  diseases,  no 
remedy  is  so  effectual  in  restoring  the  invalid  to  health,  as  a  well- 
timed  change  of  air;  and  if  the  disease  has  had  its  origin  in  causes 
dependant  upon  the  locality,  such  a  change  is  almost  essential  to 
recovery.  But  the  amount  of  benefit  to  be  derived  from  change  of 
air  will  depend  greatly  upon  the  judgment  with  which  it  is  employed 
both  as  regards  the  condition  of  the  patient  and  the  selection  of  the 
place.  The  convalescence  from  acute  diseases  should  be  fully 
established,  before  the  removal  is  attempted,  otherwise  a  relapse,  in 
place  of  improvement,  is  very  likely  to  be  the  consequence. 

Ague  affords  an  exception  to  this  rule.     In  this  disease  the  first 

'The  great  prevalence  of  pulmonary  diseases  among  the  natives  of  tropi- 
cal climates  who  come  to  this  and  other  cold  countries,  is  doubtless,  chiefly 
owing  to  the  influence  of  a  cold  and  humid  atmosphere  upon  their  system. 
It  is  in  such  persons,  and  in  young  children,  that  tuberculous  diseases  are 
more  speedily  induced,  and  where  inflammation  appears  more  intimately 
connected  with  the  production  of  tubercles.  The  rapid  progress  of  the 
disease,  in  both  classes  of  persons,  is  to  be  explained,  principally,  I  believe, 
by  the  circumstances  of  their  habit  of  body  being  that  which  is  most  dis- 
posed to  tuberculous  affections, — the  most  nearly  allied  to  tuberculous 
cachexy. 

*  See  Appendix  on  Mineral  Waters. 


56  CLARK  0$  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

intermission  should  if  possible  be  taken  advantage  of  to  remove  the 
patient  from  the  situation  in  which  it  has  occurred,  and  a  farther 
residence  in  which  will  render  the  cure  difficult.  The  remedies 
which  will  produce  little  effect  upon  an  intermittent  fever,  in  the 
locality  where  it  originated,  will  often  eifect  a  speedy  cure  when 
the  patient  is  removed  elsewhere. 

The  selection  of  the  place  will  depend  in  some  measure  on  the 
nature  of  the  complaint.  It  should  always  be  of  a  different  charac- 
ter from  that  in  which  the  patient  lives,  more  especially  in  the 
malarious  class  of  diseases  to  which  we  have  just  alluded.  For  a 
person  who  has  had  acute  pulmonary  disease,  a  mild  air  and 
sheltered  situation  will  be  the  most  favourable,  until  the  pulmonary 
irritation  has  subsided  ;  after  which  another  change  to  a  more 
bracing  air  may  be  attended  with  great  advantage,  especially  to 
persons  of  a  languid  and  relaxed  system.  The  object  desired  by 
the  first  change  is  to  soothe  and  allay  irritation  in  the  affected  organs ; 
by  the  second,  to  give  tone  to  the  system  generally.  A  succession 
of  changes  will  in  almost  all  cases  prove  more  beneficial  than  a 
residence  at  any  one  place. 

Children  profit  by  change  of  air  with  surprising  rapidity;  and 
there  are  few  cases  of  deranged  health  at  an  early  age  in  which  it 
does  not  merit  the  first  rank  in  the  list  of  remedies.  Delicate  females 
also  benefit  greatly ;  indeed,  in  proportion  to  the  natural  suscepti- 
bility of  the  individual,  is  the  beneficial  influence  of  a  judicious 
change  of  air  evinced.  It  is  to  the  young  and  delicate  the  best  and 
often~the  only  admissible  tonic;  and  we  have  daily  occasion  to 
regret  the  straitened  circumstances  which  keeps  many  such  patients 
lingering  in  a  state  between  health  and  disease,  in  the  confined  air 
of  the  city,  or  in  some  equally  unhealthy  residence  in  the  country, 
when  they  might  be  restored  to  health  and  vigour,  by  a  temporary 
change  to  a  purer  air. 


PART   THE   SECOND. 


ON  CLIMATES. 


INTRODUCTORY  REMARKS. 

Besides  Directions  for  invalids;  before  commencing  a  journey, 
while  traveling,  and  during  their  residence  abroad,  a  few  observa- 
tions on  Ventilation  and  Unhealthy  Residences  may  advantage- 
ously find  place  here,  as  the  subject  is  one  having  immediate  refer- 
ence to  that  which  has  just  been  considered,  as  well  as  to  that  about 
to  engage  our  attention. 

Ventilation. — The  necessity  of  pure  air  for  the  maintenance  of 
health  is  so  little  understood,  and  the  ventilation  of  houses  in  con- 
sequence so  thoroughly  neglected,  that  a  few  observations  on  the 
subject  will  not  be  out  of  place  in  a  work,  the  chief  object  of  which 
is  to  inculcate  the  value  and  direct  the  application  of  air  and 
climate,  as  means  of  preserving  health  and  curing  disease. 

Nothing  contributes  more  effectually  to  strengthen  the  system, 
and  render  it  capable  of  bearing  the  vicissitudes  of  climate,  than  the 
constant  respiration  of  pure  air.  On  the  other  hand,  nothing  tends 
more  certainly  to  weaken  and  relax  the  constitution,  and  render  it 
susceptible  of  the  impression  of  a  cold  and  humid  atmosphere,  than 
breathing  impure  air. 

When  an  equable  temperature  combined  with  free  ventilation  is 
generally  provided  for  in  our  houses,  there  will  be  a  great  improve- 
ment in  the  public  health. 

In  the  construction  of  a  house,  the  dimensions  of  the  bedrooms 
and  the  means  of  ventilating  them,  ought  to  be  most  important  con- 
siderations, whereas  they  are  comparatively  little  thought  of.  No- 
thing, indeed,  can  be  constructed  on  a  worse  principle  than  the 
bedrooms  in  this  country  generally  are.  Their  small  size  and  their 
lowness  render  them  very  insalubrious,  unless  well  ventilated;  and 
the  case  is  rendered  worse  by  the  close  windows,  and  by  the  thick 
curtains  with  which  the  beds  are  so  carefully  surrounded,  as  if  to 
prevent  the  possibility  of  the  air  being  renewed.  The  consequence 
is  that  the  occupants  are  breathing  vitiated  air  during  the  greater 
part  of  the  night,  that  is,  during  almost  one  half  of  their  lives.1 

1  The  remarkable  lowness  of  the  bedroom  floors  in  numerous  new  houses 
at  this  moment  building  in  and  around  London,  affords  abundant  proof  of 
the  truth  of  these  remarks. 


58  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

These  remarks,  in  regard  to  the  importance  of  free  ventilation  in 
bedrooms  are  still  more  applicable  to  nurseries,  school-rooms,  and 
all  places  occupied  by  the  young;  as  also  to  the  work-shops  of  that 
numerous  class  of  our  population  engaged  in  sedentary  occupations. 

To  secure  effective  ventilation,  or  a  continuous  renewal  of  the 
air  in  all  inhabited  rooms,  the  pure  air  should  be  made  to  enter 
from  below,  and  the  deteriorated  air  to  escape  from  above, — a  cir- 
culation in  accordance  with  the  natural  motion  produced  in  fluids 
by  difference  of  temperature,  and  prevented  only  by  the  ignorant 
interference  of  art.  To  understand  the  proper  method  of  ventilating, 
we  have  only  to  attend  to  the  currents  which  take  place  naturally 
in  all  inhabited  rooms.  Air,  as  it  increases  in  temperature,  or 
becomes  loaded  with  watery  vapour,  has  its  weight  diminished,  and 
is  forced  up,  if  means  are  not  taken  to  prevent  it.  Now  the  air  in, 
an  inhabited  apartment  being  both  heated  and  generally  combined 
with  a  portion  of  watery  vapour,  by  respiration,  &c.,  becomes  speci- 
fically lighter,  at  the  same  time  that  it  is  vitiated,  and  the  most  im- 
pure part  rises  to  the  roof.  If  it  had  the  means  of  escape,  it  would 
be  gradually  driven  out  by  an  equal  quantity  of  pure  air  entering 
below,  which,  becoming  heated  and  deteriorated  in  its  turn  would 
in  a  similar  manner  ascend  and  escape ;  thus  would  a  continual 
renewal  of  the  air  go  on  without  any  trouble  on  our  parts.  Unless 
provision  be  made  for  the  escape  of  the  ascending  current  of  impure 
air,  no  admission  of  external  air  will  secure  ventilation.1 

Unhealthy  Residences. — If  it  is  necessary  to  secure  proper  venti- 
lation within  our  dwellings,  it  is  no  less  necessary  that  the  air 
around  them  should  be  pure  and  salubrious.  The  best  internal 
arrangements  for  ventilation,  cannot  change  the  character  of  the 
external  air,  nor  prevent  its  injurious  effects  on  the  health  of  the 
inmates. 

Persons  living  in  low  damp  or  confined  situations,  rarely  enjoy 
that  degree  of  vigorous  health  of  which  their  constitution  admits. 
Without  suffering  from  any  formal  disease,  they  are  subject  to 
various  complaints  which  often  embitter  their  life,  and  render  them 
much  less  capable  of  bodily  and  mental  exertion  than  they  would 
be,  if  placed  in  a  situation  more  congenial  to  their  constitution. 

Dyspepsia,  and  its  various  concomitants,  headaches,  general 
nervous  irritability,  and  a  variety  of  anomalous  nervous  complaints, 
with  languor  and  depression  of  spirits,  may  be  enumerated  among 
the  evils  resulting  from  a  residence  in  unhealthy  situations.  All 
these  ailments,  in  addition  to  others  peculiar  to  the  sex,  are  more 
severely  felt  by  females,  because  they  are  more  susceptible,  and  at 
the  same  time  more  confined  to  the  influence  of  the  locality  in 
which  they  reside;  and  during  infancy  and  childhood,  the  effects 
of  a  confined,  humid  air  are  most  destructive ;  at  this  early  age 

*For  more  detailed  explanations  with  respect  to  ventilation  and  the  means 
by  which  it  may  be  carried  into  effect,  the  reader  is  referred  to  Dr.  Arnott's 
Elements  of  Physics •,  or  to  his  Treatise  on  Warming  and  Ventilating. 


INTRODUCTORY  REMARKS.  59 

scrofula  is  almost  the  certain  consequence  of  residing  in  such  a 
locality. 

Under  these  circumstances,  nothing  affords  so  effectual  and  speedy 
relief  as  a  change  of  residence,  even  for  a  short  time,  to  a  drier  and 
more  elevated  situation,  and  a  more  bracing  air.  In  very  many 
instances,  this  is  indeed  the  only  means  of  restoring  the  person  to  a 
better  state  of  health.  The  increase  of  strength  and  buoyancy  of 
spirit — the  mental  energy,  as  well  as  bodily  vigour,  which  persons 
residing  in  a  close  humid  atmosphere  experience  on  changing  to  a 
dry,  open,  and  elevated  part  of  the  country,  surprise  and  delight 
them,  and  they  hope  that  this  state  of  well-being  may  be  perma- 
nent; but  a  return  to  their  former  residence  soon  convinces  them 
that  their  feelings  of  increased  health  were  temporary,  and  depen- 
dent entirely  upon  their  change  of  residence. 

Much  might,  no  doubt,  be  done  to  improve  the  condition  of  many 
unhealthy  places,  by  removing  all  obstacles  to  a  free  circulation  of 
air,  and  all  sources  of  humidity,  especially  stagnant  waters,  by 
draining,  &c.  But  until  the  public  are  fully  acquainted  with  the 
circumstances  which  require  attention  in  the  selection  and  prepara- 
tion of  situations  for  building,  the  complaints  alluded  to,  and  which 
may  be  fairly  styled  malarious,  will  continue  more  or  less. 

In  a  climate  naturally  humid,  like  that  of  Great  Britain,  it  is  of 
the  first  importance  in  the  selection  of  a  situation  for  building  that 
it  should  admit  of  a  free  circulation  of  air  and  thorough  drainage. 
In  proportion  as  the  soil  is  impermeable  or  retentive  of  humidity, 
so  ought  the  site  of  the  building  to  be  high,  in  order  to  allow  of 
sufficient  fall  for  the  water  to  drain  off.  Surface  drainage  around 
houses  is  also  a  measure  which  should  never  be  neglected  when 
the  soil  is  retentive. 

Trees  and  thick  shrubbery  close  to  houses  are  not  only  direct 
causes  of  impure  humidity,  but  they  act  still  more  injuriously  by 
impeding  a  free  circulation  of  air,  and  the  entrance  of  the  sun's 
rays.  This  is  one  of  the  most  frequent,  and  I  may  add.  most  pow- 
erful causes  of  insalubrity  in  country  houses  in  England  ;  and  the 
case  is  frequently  rendered  worse  by  the  addition  of  stagnant  water, 
in  the  form  of  ponds.  Many  country  houses,  and  indeed  whole 
tracts  of  country  are  rendered  unhealthy  by  the  quantity  of  wood 
alone.  The  over-wooded  state  of  the  parks  of  many  of  the  nobility 
and  gentry,  especially  in  a  level  country,  is  a  fertile  source  of  ill- 
health,  often  of  positive  disease,  more,  especially  in  the  autumn  and 
spring,  such  as  fevers,  bowel  complaints,  rheumatism  and  other 
affections  already  alluded  to,  which,  although  not  remarkable  for 
severity,  are  not  less  causes  of  distress  from  their  great  frequency. 
Were  trees  around  houses,  and  wood  of  all  kinds,  especially  thick 
underwood,  kept  more  distant,  and  were  rank  grass,  stagnant  water, 
and  other  obvious  sources  of  impure  humidity  removed,  and  were 
more  care  taken  to  drain  the  surface  soil,  a  marked  improvement 
would  be  effected  in  the  health  of  the  inhabitants  of  the  country 


60  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

generally,  and  more  especially  in  our  thickly  wooded  and  marshy 
districts.1 

Directions  for  invalids  making  a  change  of  climate. — I  shall 
now  endeavour  to  make  the  invalid  acquainted  with  the  circum- 
stances which  demand  his  more  particular  attention,  previously  to 
setting  out, — during  his  journey,  and  after  he  is  fixed  in  his  new 
residence.  This  is  a  matter  of  the  greatest  consequence ;  and  a 
want  of  due  attention  to  it,  is  one  of  the  principal  causes  why  much 
less  benefit  is  derived  from  climate  than  would  otherwise  be  the  case. 

Too  much  is  generally  expected  from  the  simple  change  of  cli- 
mate. From  the  moment  the  invalid  has  decided  upon  making 
such  a  change,  his  hopes  are  solely  fixed  upon  it ;  while  other  cir- 
cumstances, not  less  conducive  or  necessary  to  his  recovery,  are 
considered  of  secondary  importance,  and  sometimes  totally  neglect- 
ed. This  is  an  error  not  always  confined  to  the  patient ;  his  medi- 
cal adviser  frequently  participates  in  it;  nor  is  this  difficult  to  be 
accounted  for.  The  cases  hitherto  sent  abroad  have  been,  for  the 
most  part,  consumptive,  or  other  diseases,  of  long  standing,  in 
which  the  ordinary  resources  of  our  art  have  failed ;  therefore, 
when  change  of  climate  has  at  last  been  determined  upon,  the  phy- 
sician, as  well  as  the  patient,  is  disposed  to  look  upon  it  as  the  sole 
remedy. 

But,  as  I  have  witnessed,  on  a  pretty  extensive  scale,  the  injury 
arising  from  this  over-confidence  in  the  unaided  action  of  climate, 
and  the  consequent  neglect  of  other  things  of  no  less  importance,  I 
particularly  request  the  attention  of  invalids  to  the  following  re- 
marks. 

In  the  first  place,  I  would  strongly  advise  every  person  who  goes 
abroad  for  the  recovery  of  his  health,  whatever  may  be  his  disease, 
or  to  what  climate  soever  he  may  go,  to  consider  the  change  as 
placing  him  merely  in  a  more  favourable  situation  for  the  opera- 
tion of  other  remedies  in  the  removal  of  his  disease  ;  in  fact,  to  bear 
constantly  in  mind  that  the  beneficial  influence  of  traveling,  of  sail- 
ing, and  of  climate,  requires  to  be  aided  by  such  a  dietetic  regimen 
and  general  mode  of  living,  and  by  such  remedial  measures,  as 
would  have  been  requisite  in  his  case,  had  he  remained  in  his  own 
country.  All  the  circumstances  requiring  attention  from  the  invalid 
at  home,  should  be  equally  attended  to  abroad.  If  in  some  things 
greater  latitude  may  be  permitted,  others  will  demand  even  a  more 
rigid  attention.  It  is  in  truth,  only  by  a  due  regard  to  all  those  cir- 
cumstances, that  the  powers  of  the  constitution  can  be  enabled  to 
throw  off,  or  even  materially  mitigate,  a  disease  of  long  standing,  in 
the  best  climate. 

It  may  appear  strange  to  some  of  my  readers  that  I  should  think 
it  requisite  to  insist  so  strongly  on  the  necessity  of  attending  to 

'If  a  board  of  health  existed  in  this  country,  it  would  be  part  of  their  duty 
to  draw  up  and  circulate  instructions  for  the  construction  of  buildings,  and 
the  preparations  necessary  for  rendering  them  healthy  residences. 


INTRODUCTORY  REMARKS.  61 

these  things;  but  I  witnessed  the  injurious  effects  of  a  neglect  of 
them  too  often,  not  to  deem  such  remarks  called  for  in  this  place. 
It  was,  indeed,  matter  of  surprise  to  me,  during  my  residence  abroad, 
to  observe  the  manner  in  which  many  invalids  seemed  to  lose  sight 
of  the  object  for  which  they  left  their  own  country.  This  appeared 
to  arise  chiefly  from  too  much  being  expected  from  climate. 

The  more  common  and  more  injurious  deviations  from  that  sys- 
tem of  living  which  an  invalid  ought  to  adopt,  consist  in  errors  of 
diet;  exposure  to  cold,  over-fatigue,  and  excitement  in  what  is 
called  "sight-seeing;"  frequenting  crowded  and  overheated  rooms, 
keeping  late  hours,  &c.  Many  cases  have  fallen  under  my  observa- 
tion, in  which  climate  promised  the  greatest  advantage,  but  where 
its  beneficial  influence  was  counteracted  by  the  injurious  operation 
of  these  causes.  Every  invalid  who  goes  abroad,  must  make  up 
his  mind  to  submit  to  many  sacrifices  of  his  inclinations  and  plea- 
sures, if  he  expects  to  improve  his  health  by  such  a  measure. 

In  order  that  the  patient  may  derive  advantage  from  his  journey, 
or  at  least  that  his  complaint  may  not  (as  often  happens)  be  increased 
by  it,  some  preparatory  measures  will  generally  be  requisite  before 
he  sets  out.  Traveling  is  exciting  to  most  people;  and  to  those 
who  have  chronic  inflammation  of  any  organ,  however  latent  or 
obscure,  it  very  often  proves  injurious,  particularly  during  hot  and 
dry  weather.  Almost  every  one  in  health  is  sensible  of  the  excite- 
ment arising  from  traveling.  The  appetite  is  generally  increased, 
while  the  secretions  and  excretions  are  much  diminished.  The 
consequence  is  a  degree  of  excitement  of  the  system,  not  unaptly 
termed  by  travellers,  "  a  heated  state."  What  in  health  amounts 
only  to  a  slight  degree  of  excitement,  easily  removed  by  a  few  days' 
rest,  and  the  employment  of  some  common  cooling  remedies,  often 
proves  of  serious  consequence  to  the  invalid  who  labours  under,  or 
is  even  disposed  to  any  inflammatory  affection. 

When,  therefore,  the  patient's  disease  is  of  an  inflammatory  nature, 
or  threatens  to  assume  such  a  character,  his  condition  should  be  well 
examined  before  he  commences  a  journey  or  voyage.  If  any  undue 
vascular  excitement  exists,  measures  should  be  taken  to  reduce  it 
by  proper  regimen, — by  rest,  by  tepid  bathing,  &c. ;  and  local,  or 
even  general  bleeding  may  be  requisite  in  some  cases.  Simple  con- 
gestion, or  an  overloaded  state  of  the  vascular  system,  general  or 
local,  will  also  require  to  be  diminished.  In  short,  before  one  step 
of  the  journey  is  taken,  all  excitement  or  plethora  should  be  removed, 
as  far  as  the  nature  of  the  case  admits. 

Having  his  system  in  a  proper  state  when  he  sets  out,  the  invalid 
should  endeavour  to  keep  it  so  during  the  journey, — by  adhering  to 
a  light  diet,  taking  care  not  to  overload  the  stomach  even  with  the 
mildest  food,  by  abstaining  from  wine  and  spirits  of  every  kind,  and 
by  maintaining  the  regular  action  of  the  bowels.  The  latter  object 
is  best  effected  by  laxatives,  such  as  castor  oil,  and  electuary  of 
senna,  or  by  the  use  of  mild  lavements.  Purgatives  of  the  more 
drastic  kind,  such  as  generally  enter  into  the  composition  of  pills, 


62  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

are  apt  to  irritate  the  bowels,  increase  an  attack  of  hemorrhoids,  a 
frequent  consequence  of  neglected  or  irritated  bowels  while  travel- 
ing. When  such  medicines  are  used  they  should  be  of  the  least 
irritating  nature,  and  the  dose  so  regulated  as  to  produce  a  laxative 
effect  only.  The  watery  extract  of  aloes,  with  mastich  and  extract 
of  hyosciamus,  forms  one  of  the  best  combinations.  To  these  means 
of  maintaining  the  system  in  a  cool  state,  I  may  add  the  use  of 
warm  or  tepid  bathing,  which  should  not  be  omitted  where  it  can 
be  conveniently  procured,  and  when  there  are  no  objections  to  it 
from  the  peculiar  nature  of  the  patient's  disease.  When  used  with 
the  necessary  precaution  it  is  free  from  danger,  and  will  generally 
prove  very  useful  in  obviating  the  exciting  effects  of  traveling.  The 
temperature  may  be  from  94°  to  97°  of  Fahrenheit's  thermometer, 
according  to  the  feelings  of  the  patient.  The  forenoon,  or.  rather, 
just  before  dinner,  is  the  best  period  for  taking  the  bath,  and  from 
twenty  minutes  to  half  an  hour  the  proper  time  for  remaining  in  it. 
By  adopting  the  general  regimen  mentioned,  and  by  traveling  such 
distances  only  as  the  strength  can  bear,  resting  for  a  day  when  it  is 
found  necessary,  the  invalid  will  not  only  escape  the  injurious 
effects  frequently  produced  by  traveling,  but  arrive  at  his  winter 
residence  in  a  much  better  state  of  health  than  when  he  left  his 
own  country.  This,  I  may  observe,  however,  is  a  rare  occurrence 
in  the  usual  mode  of  conducting  a  long  journey ;  for,  even  when 
no  positive  increase  of  disease  is  the  result,  the  traveller  has  fre- 
quently sufficient  cause  to  regret  his  inattention  to  the  precautions 
above  mentioned;  as  there  is  induced  a  degree  of  general  excite- 
ment, and  a  deranged  state  of  the  secreting  organs  in  particular  ;  the 
injurious  effects  of  which  may  be  felt  by  a  delicate  constitution  dur- 
ing a  considerable  part  of  the  winter.  The  invalid  thus  not  only 
loses  the  benefit  which  the  journey  might  have  produced,  but,  in 
part,  that  also  which  he  would  have  obtained  from  his  winter  resi- 
dence. If  the  invalid  is  wise,  he  will  keep  these  things  in  mind. 
It  is  the  duty  of  his  medical  adviser  to  prepare  him  for  his  journey, 
by  allaying  any  excitement  which  may  exist  in  his  system,  and  by 
removing  any  other  morbid  affections  with  which  the  principal  dis- 
ease may  be  complicated,  and  which  often  form  insurmountable 
obstacles  to  recovery. 

Having  his  system  thus  prepared,  the  invalid  should,  on  his  part, 
endeavour  to  maintain  it  in  the  same  state,  by  a  strict  adherence  to 
the  prescribed  regimen.  If,  during  his  journey,  his  pulse  should 
become  frequent,  his  skin  dry  and  hot,  or  if  he  has  thirst  or  a  dry 
tongue  in  the  morning,  or  if  his  nights  are  restless,  he  may  feel  as- 
sured all  is  not  right.  He  is  over  excited,  either  by  too  full  a  diet, 
by  too  rapid  traveling,  by  exposure  to  a  hot  sun,  or  by  the  bowels 
being  overloaded.  In  the  generality  of  such  cases,  a  few  days'  rest, 
and  the  use  of  some  such  cooling  remedies  as  have  already  been 
mentioned,  will  allay  the  irritation  ;  and  the  invalid  may  then  pur- 
sue his  journey,  taking  care  to  avoid  whatever  he  has  reason  to 
believe  excited  him  before. 


INTRODUCTORY  REMARKS.  63 

Arrived  at  his  place  of  residence,  some  measures  of  the  same 
kind  will  probably  be  necessary ;  as  it  will  rarely  happen,  that  one 
shall  reach  the  end  of  a  long  journey,  even  under  the  best  manage- 
ment, without  some  degree  of  temporary  excitement  or  derange- 
ment of  the  system.  The  invalid  should,  if  possible,  be  spared  the 
examination  and  selection  of  apartments,  and  particular  care  should 
be  taken  to  have  these  thoroughly  dry  and  ventilated  before  he 
enters  them ;  this,  I  may  remark  in  passing,  is  not  to  be  done  in 
any  part  of  the  continent  of  Europe,  without  the  use  of  fires. 

There  are  some  other  circumstances  more  immediately  connected 
with  the  change  of  climate,  which  require  to  be  noticed  here.  As 
the  traveller  advances  to  the  south,  the  sensibility  of  the  system  is 
increased,  and  hence  his  mode  of  living  should  be  regulated  accord- 
ingly. Persons,  for  example,  bear  a  diet  in  England  which  would 
prove  too  exciting  to  them  in  Italy :  some  articles  of  food,  also,  are 
more  apt  to  disagree  in  the  south ;  of  this  kind  are  fish,  milk,  and 
even  vegetables,  all  of  which  should  be  used  in  great  moderation  by 
persons  in  delicate  health.  As  soon,  therefore,  as  a  person  changes 
his  climate,  he  ought  to  adapt  his  manner  of  living  to  that  which 
he  has  begun  to  inhabit.  Besides  the  diet,  the  clothing  also  requires 
particular  attention.  This  should  be  as  warm  during  the  winter 
in  the  south  of  Europe  as  in  England.  The  feelings  are  altered 
in  respect  to  temperature,  and  houses  being  relatively  colder  in 
Italy,  warmer  clothing  is  necessary  within  doors  than  in  this 
country.  It  is  advisable,  also,  to  keep  the  whole  apartment  at  a 
moderate  temperature,  and  to  avoid  approaching  too  near  the  fire. 
To  seek  also  too  exclusively  the  sun's  rays  is  a  habit  particularly 
injurious  in  the  south  of  Europe,  more  especially  during  the  spring. 
Prom  these  causes  arise  headaches,  catarrhs,  inflammatory  affections 
of  the  chest,  and  even  fevers. 

This  seems  the  proper  place  to  say  something  of  the  best  periods 
of  traveling.  With  respect  to  the  routes  to  the  different  parts  of  the 
Continent  the  ordinary  Guides  and  books  of  Directions  for  travel- 
lers, contain  such  full  information  as  to  render  it  unnecessary  that 
I  should  enter  on  that  subject. 

There  are  two  seasons  when  the  invalid,  who  means  to  pass  the 
winter  in  Italy,  may  best  leave  England,  early  in  June  and  early  in 
September.  In  setting  out  at  the  former  period,  he  may  pass  the 
summer  in  Germany  or  Switzerland, — a  plan  which  will  suit  the 
health  of  many.  By  leaving  this  country  in  September,  the  sum- 
mer heat  will  be  avoided,  and,  by  conducting  the  journey  properly, 
the  patient  may  enjoy  a  mild  climate  to  the  place  of  his  destination. 
But  to  insure  this,  nothing  should  be  allowed  to  interfere  with  the 
steady  progress  of  the  journey,  except  such  periods  of  repose  as  the 
invalid  may  require.  The  best  route  will  be  through  Switzerland, 
and  across  the  Simplon.  The  proper  time  for  entering  Italy  is  the 
end  of  September,  or  early  in  October. 

For  Nice  and  the  south  of  France,  the  period  of  departure  need 
not  be  quite  so  soon.  Although  an  invalid  can  scarcely  have  too 


64  CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

much  time  for  his  journey;  inasmuch  as.  if  conducted  with  judg- 
ment, and  made  at  the  proper  season,  it  will  be  more  beneficial  to 
his  health  the  more  time  it  occupies,  within  reasonable  limits. 
When  the  weather  is  chilly,  the  invalid  should  not  commence  his 
journey  too  early  in  the  morning,  nor  until  he  has  taken  a  light 
breakfast ;  and  he  should  endeavour  to  arrive  at  his  sleeping  quar- 
ters before  evening. 

One  of  the  most  exciting  things  to  a  sensitive  invalid  is  exposure 
to  a  powerful  sun  ;  this  should  therefore  be  sedulously  avoided,  by 
resting  during  the  middle  of  the  day  when  the  weather  is  oppres- 
sively hot. 

When  there  is  a  disposition  to  coldness  of  the  extremities,  it  is  of 
essential  consequence  to  the  well-being  of  the  patient,  to  guard 
against  this.  If  the  surface  and  extremities  are  kept  warm,  a  deli- 
cate person  will  often  bear  traveling  in  a  very  cool  atmosphere,  and 
even  derive  advantage  from  it.  Persons  with  the  slightest  disposi- 
tion to  inflammation  of  the  throat,  trachea,  or  lungs,  should  avoid 
exposure  to  cold  or  high  winds,  or  a  powerful  sun,  and,  still  more, 
alternations  of  these,  which  are  very  apt  to  occur  in  valleys,  and  in 
crossing  mountains.  Invalids  should  also  avoid  approaching  too 
near  a  strong  fire  in  the  evenings  after  a  journey. 

The  foregoing  observations  I  consider  to  apply,  more  or  less,  to 
all  invalids  going  abroad  for  the  benefit  of  their  health :  more 
minute  instructions  respecting  the  conduct  of  those  affected  with 
particular  diseases,  and  while  residing  at  different  places,  will  be 
found  in  the  articles  devoted  to  the  consideration  of  such  diseases 
and  places. 


CLIMATES  OF  ENGLAND. 

I  shall  commence  my  survey  of  climates  for  invalids,  with  the 
most  favourable  for  winter  residences  in  this  country.  In  my 
account  of  these  I  shall  have  occasion  to  compare  them  with  each 
other,  and  with  the  most  esteemed  climates  in  the  south  of  Europe; 
both  in  regard  to  their  physical  qualities,  and  their  influence  on 
diseases. 

The  Mild  Region  of  England  admits  of  being  divided  into  four 
districts,  or  groups  of  Climate ;  that  of  the  South  Coast  compre- 
hending the  tract  of  coast  between  Hastings  and  Portland  Island ; 
the  Southwest  Coast,  from  the  latter  point  to  Cornwall ;  the  district 
of  the  Lands- End ;  the  Western  Group,  comprehending  the 
places  along  the  borders  of  the  Bristol  Channel  and  estuary  of  the 
Severn.  We  shall  find  that  each  of  these  regions  has  some  peculiar 
features  in  its  climate  which  characterise  it,  and  distinguish  it  from 
the  others,  both  as  regards  its  physical  and  medical  qualities. 


CLIMATES  OP  ENGLAND.  65 


LONDON. 

As  a  point  of  comparison,  and  for  other  reasons,  it  will  be  useful 
to  begin  with  a  brief  notice  of  the  climate  of  the  metropolis.  Lon- 
don is  indebted  for  the  peculiarities  of  its  climate  to  artificial  cir- 
cumstances chiefly.  To  the  crowded  assemblage  of  so  many  living 
beings  ;  the  multifarious  processes  ministering  to  their  wants ;  the 
countless  operations  of  art ;  the  influence  of  buildings,  &c.  in  re- 
taining, augmenting  and  diffusing  warmth,  by  reflection,  by  radia- 
tion, and  in  other  ways.  Besides  these,  the  more  indirect  influence 
of  perfect  draining  and  paving,  in  contributing  to  maintain  a  dry 
state  of  the  soil  and  atmosphere,  must  be  taken  into  account.  All 
these  circumstances  tend,  some  in  a  greater,  others  in  a  less  degree, 
to  the  creation  of  a  peculiar  climate  in  London.  As  regards  tem- 
perature, we  have  their  influence  very  accurately  demonstrated ; 
but  the  subject  becomes  more  difficult  when  we  would  discover  the 
other  elements  which  constitute  the  complex  problem  of  climate. 

The  mean  annual  temperature  of  London  is  50°  39,  being  one 
and  a  half  decree  above  that  of  the  environs.1 

This  difference  of  temperature  between  the  metropolis  and  sur- 
rounding country  is  very  unequally  distributed  throughout  the 
year,  and  throughout  the  day.  The  excess  of  the  city  tempe- 
rature is  greater  in  winter  than  in  summer.  It  is  at  its  maximum 
in  January,  at  whicb  time  it  exceeds  that  of  the  environs  by  3°. 
In  the  spring  months,  the  temperature  of  the  environs  becomes 
nearly  equal  to,  and  in  the  month  of  May  rather  exceeds  that 
of  London.  That  accurate  observer,  Howard,  further  shows,  that 
this  excess  of  temperature  of  the  city  "belongs,  in  strictness,  to 
the  nights  ;  which  average  three  degrees  and  seven  tenths  warmer 
than  in  the  country;  while  the  heat  of  the  day,  owing  without 
doubt,  to  the  interception  of  a  portion  of  the  solar  rays  by  a 
constant  veil  of  smoke,  falls,  on  a  mean  of  years,  about  a  third  of 
a  degree  short  of  that  on  the  open  plain."2  As  was  also  to  have 
been  expected,  the  temperature  of  London  does  not  show  so  exten- 
sive a  range  between  its  extremes,  either  during  the  year,  the  month; 
or  the  day,  as  the  temperature  of  its  environs ;  and  the  amount  of 
variation  between  the  successive  days,  which  shows  the  steadiness 
of  temperature,  is  also  considerably  less  in  the  former  than  in  the 
latter.  Howard's  observations,  also,  prove  that  although  London 
is  warmer  than  the  country,  it  acquires  and  loses  its  heat  more 
slowly.  It  will  be  the  duty  of  the  physician  to  decide  how  far  this 
gain  in  warmth,  (more  particularly  in  the  night,)  in  steadiness  of 

'The  temperature  of  the  environs  is  calculated  from  Howard's  observa- 
tions made  at  Plaistow.  Stratford,  and  Tottenham-Green. 

2  The  Climate  of  London,  deduced  from  Meteorological  Observations 
made  in  the  Metropolis,  and  at  various  Places  around  it.  By  Luke  Howard, 
Gent.  Second  Edition,  vol.  i.  p.  237.  London,  1833. 

1 — e  5  dark 


66  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

temperature,  and  in  a  greater  degree  of  dryness  and  stillness,  is 
counterbalanced  by  a  diminution  of  the  purity  of  the  atmosphere, 
and  of  other  qualities  of  climate.  The  benefit  so  often  experienced 
by  delicate  invalids  on  coming  from  the  country  to  London,  in  the 
winter  or  spring,  is  no  doubt  owing  to  the  qualities  of  the  climate 
above  enumerated.  It  is  during  the  night  that  the  climate  possesses 
the  greatest  advantages  for  the  sensitive  invalid ;  in  addition  to  its 
warmth  and  dryness  the  atmosphere  is  then  in  its  purest  state, 
being  free  from  the  smoke  and  dust  with  which  it  is  loaded  and 
obscured  during  the  day,  by  the  numerous  fires  and  the  unceasing 
traffic  of  carriages,  &c. 

I  shall  not  at  present  enter  more  fully  upon  the  consideration  of 
the  Climate  of  London  :  its  peculiarities  will  be  made  more  apparent 
in  the  sequel,  by  the  frequent  comparisons  which  we  shall  have 
occasion  to  make  between  it  and  the  other  climates  which  we  pur- 
pose to  describe  :  anfl  in  the  mean  time,  I  can  confidently  refer  those 
who  are  desirous  of  further  information  on  the  subject,  to  the  excel- 
lent work  of  Mr.  Howard,  just  referred  to,  and  also  to  the  memoir 
of  Professor  Daniel,  in  his  ingenious  Meteorological  Essays. 

THE  SOUTH  COAST. 

This  extensive  and  populous  coast,  from  its  vicinity  to  the  metro- 
polis, and  more  easy  access  generally,  possesses  several  obvious 
advantages  over  the  more  distant  parts  of  our  Island.  Various 
places  along  it  are  more  or  less  frequented  by  invalids,  who  migrate 
from  the  northern  and  interior  parts  of  the  island  in  search  of  milder 
seasons ;  but  here,  as  elsewhere,  we  have  to  regret  that  more  regis- 
ters of  the  weather  have  not  been  kept.  For  want  of  more  general 
data,  our  observations  can  apply  correctly  only  to  Hastings,  Brighton, 
Chichester,  Gosport,  Southampton,  and  Undercliff,  in  the  Isle  of 
Wi£ht. 

Were  we  to  rest  contented  with  the  result  of  the  mean  annual 
temperature,  we  should  find  that  there  was  very  little  difference 
between  that  of  the  South  Coast  and  of  London.  But  when  we 
descend  to  particulars,  we  observe  that  there  does  exist  a  consider- 
able difference  in  their  temperature,  arising  from  the  mode  of  its 
distribution.  It  is  because  the  higher  degree  of  the  temperature  of 
London,  and  the  interior  of  the  island  in  summer,  compensates  for 
the  lower  degree  in  the  winter,  that  the  climate  of  these  places 
appear  to  equal  that  of  the  South  Coast.  The  mean  temperature  of 
the  latter,  however,  during  the  winter  months,1  is  from  one  to  two 
degrees  above  that  of  London.  The  superiority  is  greatest  in  those 
months  in  the  following  order  : — January,  February,  December.  It 

llt  may  be  proper  here  to  state  that,  in  this  work  I  adopt  the  more  com- 
mon division  of  the  seasons ;  including  under  Winter,  the  months  of  Decem- 
ber, January,  and  February ;  under  Spring,  those  of  March,  April,  and  May  ; 
under  Summer,  June,  July,  and  August;  and  under  Autumn,  September, 
October,  and  November. 


CLIMATES  OF  ENGLAND.  67 

diminishes  in  March ;  and  in  April  the  temperature  of  the  coast 
falls  nearly  two  degrees  below  that  of  London  and  its  vicinity  j1  in 
May,  it  is  a  degree  and  a\half,  and  in  the  months  of  June,  July, 
August,  and  September,  about  one  degree  less.  In  October,  the 
mean  temperatures  are  nearly  equal,  but  in  November  that  of  the 
coast  begins  to  rise  above  trve^other. 

It  is  important  to  remark,  that  the  difference  of  temperature,  in 
favour  of  the  coast,  during  the  winter,  occurs  principally  between 
the  lower  extremes ;  so  that  the  temperature  of  the  day  is  nearly 
the  same  at  both  places,  whilst  that  of  the  night  is  considerably 
warmer  on  the  coast.  For  instance,  the  difference  between  the 
minima  of  Gosport  and  London,  during  the  winter,  is  to  the  differ- 
ence of  their  maxima  as  seven  to  three.  The  minimum  tempera- 
ture, observed  on  the  South  Coast  generally,  is  from  three  to  four 
degrees  above  the  minimum  temperature  observed  at  London.  Nor 
is  the  temperature  of  the  South  Coast  subject  to  the  same  extent 
of  range  as  that  of  London  and  the  interior.  Thus,  the  difference 
of  the  mean  temperature  of  the  warmest  and  coldest  months  in  Lon- 
don is  26°,  while  at  Gosport  it  is  only  21°;  and  the  mean  of  the 
monthly  ranges  at  London  is  34°,  and  at  Gosport  only  31°.  In 
steadiness  of  climate,  as  deduced  from  the  variation  of  temperature 
between  successive  days,  the  South  Coast  does  not  appear  to  possess 
any  very  remarkable  superiority  over  London  itself.  Of  the  places 
on  this  tract  of  coast  which  have  been  particularly  examined, 
Southampton  is  the  most  variable  in  its  temperature,  equaling  in 
this  respect  the  environs  of  London. 

More  rain  falls  on  the  South  Coast  than  at  London,  the  ratio 
being,  as  nearly  as  could  be  ascertained,  as  30  to  25 :  but  the  quan- 
tity varies  considerably  at  different  parts.  Of  the  places  on  this 
coast,  frequented  by  invalids,  Hastings,  Brighton,  and  Undercliff, 
may  be  considered  as  having,  respectively,  peculiar  climates. 

HASTINGS. 

This  place  has  long  enjoyed  the  reputation  of  being  one  of  the 
mildest  and  most  sheltered  winter  residences  on  the  South  Coast. 
Owing  to  its  low  situation,  and  the  height  of  the  neighbouring 
cliffs,  it  is  protected  in  a  considerable  degree  from  all  northerly 
winds.  To  those  of  the  south  it  is  fully  exposed ;  and  although 
the  gales  from  that  quarter  are  less  violent  on  this  coast  than  on 
that  of  Cornwall  and  Devonshire,  still,  during  the  winter  season, 
southwesterly  winds  often  prevail  many  days  successively.  In  re- 
spect of  the  degree  of  protection  from  northerly  and  northeasterly 
winds,  there  is  a  considerable  difference  in  different  parts  of  Hast- 

1  On  the  parts  of  the  coast  which  are  more  particularly  exposed  to  the  in- 
fluence of  the  northeast  winds,  this  difference  of  temperature  between  the 
coast  and  the  interior  is  still  greater,  when  estimated  by  its  effects  on  the 
living  body. 

5* 


68  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

ings.1  The  lower  situations  facing  the  beach  are  particularly  well 
sheltered  by  a  perpendicular  cliff  which  rises  immediately  behind 
them.  Other  parts  of  the  town  are  more  or  less  exposed,  according 
to  their  elevation  and  aspect.  In  another  point  of  great  importance 
in  the  character  of  a  winter  residence  for  invalids,  I  allude  to 
sheltered  exercising  ground,  Hastings  is  not  very  favourably  cir- 
cumstanced. It  is  true,  the  parade  affords  a  sheltered  walk  of  small 
extent,  close  upon  the  beach,  and  there  is  a  ride  along  the  shore, 
through  St.  Leonards,  which  is  protected  by  a  range  of  cliffs  from 
northerly  winds  ;  but  it  is  the  only  sheltered  ride  of  any  extent  in 
the  neighbourhood. 

With  respect  to  the  comparative  merits  of  this  climate,  it  may  be 
observed,  that  its  superiority  in  winter  appears  to  be  confined  chiefly 
to  the  months  of  January  and  February.  During  these  two  months, 
and  in  the  spring  also,  it  has  the  advantage  of  being  more  effectual- 
ly sheltered  from  north  and  northeast  winds,  than  the  other  places 
frequented  by  invalids  on  the  coast  of  Sussex.  Hastings  is  said  to 
be  comparatively  little  subject  to  fogs  in  the  spring;  the  fall  of  rain 
is  also  said  to  be  less  than  at  other  parts  of  the  same  coast. 

As  might  be  expected  from  the  low  and  sheltered  situation  of 
Hastings,  it  will  be  found  a  favourable  residence  generally  to  inva- 
lids labouring  under  diseases  of  the  chest.  Delicate  persons,  who 
require  to  avoid  exposure  to  the  northeast  winds,  may  pass  the  cold 
season  here  with  advantage.  But  in  recommending  Hastings  as  a 
residence  in  both  instances,  it  will  be  necessary  to  take  into  con- 
sideration the  influence  of  sea  air ;  for,  owing  to  the  close  manner 
in  which  this  place  is  hemmed  in  on  the  sea  by  steep  and  high  cliffs 
it  has  an  atmosphere  more  completely  marine  than  almost  any  othe. 
part  of  this  coast,  with  the  exception  of  St.  Leonards. 

Judging  from  my  own  observation,  I  should  say  that  the  climate 
of  Hastings  is  unfavourable  in  nervous  complaints,  more  especially 
in  nervous  headachs  connected  with,  or  entirely  dependent  upon 
an  irritated  condition  of  the  digestive  organs,  and,  also,  in  cases 
where  a  disposition  to  apoplexy  or  epilepsy  has  been  manifested. 
But  it  will  be  understood  from  what  has  been  already  stated  re- 
specting the  topographical  relations  of  Hastings,  that  this  effect  of 
its  climate  is  chiefly  experienced  in  the  lower  or  more  confined 
parts  ;  nor  is  such  an  effect  peculiar  to  this  place  ;  it  is  common,  I 
believe,  to  all  places  similarly  situated.  The  class  of  persons  alluded 
to,  if  induced  to  reside  for  any  length  of  time  at  Hastings,  should 
avoid  the  more  confined  situations  below  the  cliff,  and  rather  seek 
such  quarters"  as  are  more  open  and  elevated,  yet  in  some  degree 
protected  from  north  arid  northeast  winds. 

1  On  the  Curative  Influence  of  the  Southern  Coast,  &c,,  p.  23.  Also,  On 
the  Adaptation  of  the  Different  Parts  of  Hastings  to  Different  Diseases.  By 
Dr.  Harwood. 


CLIMATES  OF  ENGLAND.  69 


ST.  LEONARDS. 

This  place  is  about  a  mile  to  the  westward  of  Hastings,  and, 
like  it,  possesses  a  dry  and  absorbent  soil.  St.  Leonards  is  separated 
from  the  sea  beach  merely  by  a  carriage  road  and  broad  esplanade, 
and  lies  along  the  base  of  a  range  of  cliffs  which  protect  it  from 
northerly  winds.  The  circulation  of  the  sea  atmosphere  is  more 
free  and  uninterrupted  here  than  at  Hastings,  and  the  cliffs  being 
lower,  cold  draughts,  and  counter-currents  of  wind  from  above  are 
less  experienced.  The  breadth  and  extent  of  its  esplanade  also, 
and  the  protection  afforded  by  the  colonnades  for  walking  exercise, 
are  circumstances  of  considerable  importance  to  the  invalid. 

In  other  respects,  the  climate  of  St.  Leonards  may  be  considered 
as  almost  identical  with  that  of  Hastings. 

Dr.  Harwood  thinks  Hastings  and  St.  Leonards  most  favourable 
for  invalids  from  November  to  the  end  of  February.1 

In  the  extent  and  quality  of  accommodations,  St.  Leonards  much 
exceeds  Hastings. 

Ague  is  not  unfrequent  in  the  neighbouring  districts ;  but  Dr. 
Harwood  never  knew  an  instance  of  a  visitant  being  attacked  with 
the  complaint. 

BRIGHTON. 

Brighton  has  a  climate  in  many  respects  the  reverse  of  that  of 
Hastings,  the  air  being  dry,  elastic  and  bracing;  yet  even  within 
the  limits  of  Brighton  a  considerable  diversity  of  climate  is  to  be 
found.  The  true  character  of  the  Brighton  climate  belongs,  in 
strictness,  to  the  part  of  the  town  east  of  the  Steyne ;  here  the  air 
is  eminently  dry,  sharp,  and  bracing.  That  to  the  westward  is 
somewhat  damp,  but  milder.  Delicate,  nervous  invalids  are  very 
sensible  of  this  difference,  and  generally  feel  better  in  the  western 
part.  Those  who  suffer  from  a  relaxed  state  of  the  system,  enjoy 
their  health  more  fully  on  the  Marine  Parade.  The  Steyne  forms 
an  intermediate  climate,  being  sheltered  in  some  degree  from  the 
cold  northeasterly  winds,  on  the  one  hand,  and  the  boisterous  south- 
westerly winds  on  the  other. 

Compared  with  the  other  parts  of  this  coast,  the  climate  of  Brigh- 
ton appears  to  the  greatest  advantage  in  the  autumn  and  early  part 
of  the  winter;  when,  as  we  have  seen,  it  is  somewhat  milder,  and 
more  steady  than  that  of  Hastings.  Accordingly,  in  all  cases  in 
which  a  dry  and  mild  air  proves  beneficial,  Brighton,  during  this 
period  of  the  year,  deserves  a  preference  over  every  other  part  of 
the  South  Coast  which  I  have  had  an  opportunity  of  observing. 
During  the  spring  months,  on  the  other  hand,  owing  to  its  exposure 

1  On  the  Climate  of  the  Hastings  Coast;  Viewed  in  Refeience  to  its  Ef- 
fects in  Diseases  of  the  Throat  and  Chest.  By  John  Harwood,  M.D.,  F.R.S. 


70  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

to  the  northeasterly  winds,  this  climate  proves  cold,  harsh,  and  ex- 
citing to  delicate  constitutions.  At  this  season,  therefore,  sensitive 
invalids  generally,  and  more  especially  persons  with  delicate  chests, 
should  avoid  Brighton.  The  climate  of  Hastings,  as  I  have  already 
remarked,  is  milder  in  the  latter  part  of  the  winter  and  spring. 

For  convalescents,  and  all  persons  who  require  a  dry  and  bracing 
air,  and  in  whose  cases  the  sea  shore  is  suitable,  Brighton  presents 
one  of  the  most  favourable  climates  which  can  be  selected.  For 
children  and  young  persons  generally,  it  forms  an  excellent  resi- 
dence. A  large  proportion  of  invalids  also,  who  require  to  pass 
the  winter  in  the  warmer  parts  of  our  island,  may  remain  with 
great  advantage  at  Brighton  during  the  autumn.  The  weather  is 
then  generally  mild,  and  favourable  for  exercise  on  horseback,  or 
otherwise,  particularly  as  from  the  calcareous  nature  of  the  soil, 
rain  dries  up  with  great  rapidity.  There  is  certainly  something 
very  peculiar  in  the  influence  of  the  air  of  Brighton  upon  the 
nervous  system.  I  believe  that  relaxed  nervous  invalids,  whom  it 
does  not  irritate,  feel  more  vigour  and  energy  here  than  at  almost 
any  place  with  which  I  am  acquainted ;  on  the  other  hand,  persons 
of  an  irritable  nervous  system,  or  those  subject  to  gastritic  dyspepsia, 
or  a  dry  irritable  state  of  skin,  will  not  derive  advantage  from  the 
climate  of  Brighton  ;  on  the  contrary,  their  complaints  will  gene- 
rally be  aggravated  by  it.  From  the  disposition  to  gastric  irritation 
experienced  at  Brighton,  invalids,  and  dyspeptic  invalids  in  par- 
ticular, should  adhere  to  a  mild  diet,  more  especially  on  their  first 
arrival. 

From  Brighton,  the  delicate  invalid  may  remove  during  the 
winter  and  spring  to  the  more  sheltered  situations  afforded  by 
Undercliff,  Hastings,  or  Torquay,  a  plan  which  will  prove  more 
advantageous  to  many  invalids  than  passing  the  whole  season  at 
any  one  of  these  places. 

ISLE  OB1  WIGHT. 

The  Isle  of  Wight,  from  the  variety  which  it  presents  in  point 
of  elevation,  soil,  and  aspect,  and  from  the  configuration  of  its  hills 
and  shores,  possesses  several  peculiarities  of  climate  and  situation, 
which  render  it  a  very  favourable  residence  for  invalids  throughout 
the  year. 

The  part  of  the  island  adapted  as  a  winter  residence  for  invalids, 
is  that  denominated  Undercliff,  which  comprehends  a  tract  of  coun- 
try, extending  from  Dunnose  to  St.  Catherine's  Hill,  on  the  south- 
east coast,  about  six  miles  in  length,  and  from  a  quarter  to  half  a 
mile  in  breadth.  This  singular  district  consists  of  a  series  of  ter- 
races, formed  by  the  upper  strata,  composed  of  chalk  and  green 
sand,  which  have  slipped  down  from  the  cliffs  and  hills  above,  and 
been  deposited  in  irregular  masses  upon  a  substratum  of  blue  marl. 
The  whole  of  the  Undercliff,  which  presents  in  many  places  scenery 
of  the  greatest  beauty,  is  dry  and  free  from  moist  or  impure  exhala- 


CLIMATES  OF  ENGLAND.  71 

tions,  and  is  protected  from  the  north,  northeast,  northwest,  and 
west  winds,  by  a  range  of  lofty  downs,  or  hills  of  chalk  and  sand- 
stone, which  rise  boldly  from  the  upper  termination  of  these  terraces, 
in  elevations  varying  from  four  to  six  and  seven  hundred  feet ;' 
leaving  Undercliff  open  only  in  a  direct  line  to  the  southeast,  and 
obliquely  to  the  east  and  southwest  winds,  which  rarely  blow  here 
with  great  force. 

The  physical  structure  of  the  Undercliff  has  been  carefully  in- 
vestigated and  described  by  the  geologist,2  and  the  beauties  of  its 
scenery  have  been  often  dwelt  upon  by  the  tourist,  but  its  far  more 
important  advantages,  as  a  winter  residence  for  the  delicate  invalid, 
seem  but  recently  to  have  attracted  attention. 

The  continuous  range  of  high  hills  which  separates  this  district 
from  the  rest  of  the  island,  protects  it  most  effectually  from  all 
northerly  winds  ;  while  numerous  short  ridges,  projecting  from  the 
main  range  towards  the  sea,  break,  in  a  considerable  measure,  the 
violence  of  the  southwest  winds.  The  protection  afforded  by  this 
northern  barrier  is  greatly  increased  by  the  very  singular  arid 
striking  abruptness  with  which  it  terminates  on  its  southern  aspect. 
This,  in  many  places,  consists  of  the  bare,  perpendicular  rock  of 
sandstone,  in  others,  of  chalk,  assuming  its  characteristic  rounded 
form,  covered  with  fine  turf  and  underwood  ;  but  so  steep  as  to 
justify  the  appellation  conferred  on  the  beautiful  tract  which  ex- 
tends from  its  base  to  the  sea  shore.3  The  defence  afforded  by  this 
natural  bulwark  against  northerly  winds  is,  indeed,  more  perfect 
than  any  thing  of  the  kind  I  have  met  with  in  this  country  ;  and 
the  transition  of  climate  experienced  on  descending  from  the  exposure 
of  the  open  and  elevated  down  to  the  shelter  of  the  Undercliff,  will 
remind  the  Italian  traveller  of  his  sensations  on  entering  the  valley 
of  Domodossola,  after  quitting  the  chilly  defiles  of  the  Simplon,  in 
an  autumn  evening.  You  feel  at  once  that  you  have  entered  a  new 
climate  ;  and  the  luxuriance  of  the  vegetable  tribes,  which  you  find 
around  you,  proves  that  the  impression  made  on  the  senses  has  not 
been  deceitful. 

The  whole  of  the  Undercliff,  however,  is  not  protected  in  an 
equal  degree.  The  eastern  part,  comprehending  the  country  from 
Bonchurch  to  the  village  of  St.  Lawrence,  a  distance  of  nearly 
three  miles,  has,  in  this  respect,  the  advantage  over  the  western 
portion,  which  is  more  open  to  the  southwesterly  winds  ;  but  even 
here  there  are  several  very  sheltered  spots ;  and  the  temperature 
does  not  differ  materially  from  that  of  the  eastern  division.  The 

1  The  height  of  the  range  is  greatest  at  its  two  extremities ;  St.  Catherine's 
Hill  is  nearly  900,  and  St.  Boniface  Down  800  feet  above  the  level  of  the 
sea.     The  intermediate  parts  of  the  range  vary  from  650  to  700  feet. 

2  See  the  splendid  work  of  Sir  Henry  C.  Englefield,  (which  contains  Mr. 
Webster's  geological  observations,)  "A  Description  of  the  Principal  Pic- 
turesque Beauties,  Antiquities,  and  Geological  Phenomena  of  the  Isle  of 
Wight."    London,  1816. 

'Undercliff,  i.  e.  under  the  cliff. 


72  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

whole  extent  of  Undercliff  is,  indeed,  sigularly  protected  from  winds; 
and,  I  apprehend,  it  will  he  difficult  to  find,  in  any  northern  coun- 
try, a  tract  of  equal  extent  and  variety  of  surface,  and  I  may  add, 
(as  by  no  means  a  matter  of  indifference  to  the  invalid,)  of  equal 
beauty  in  point  of  scenery,  so  completely  screened  from  the  cutting 
northeast  winds  of  the  spring,  on  the  one  hand,  and  from  the 
boisterous  southerly  gales  of  the  autumn  and  winter,  on  the  other. 
The  termination  of  the  Undercliff  towards  the  sea  shore  is  in  a 
range  of  perpendicular  cliffs,  of  from  forty  to  sixty,  or  seventy  feet 
in  height,  rendering  it  far  from  being  a  close  and  confined  situation, 
a  circumstance  of  no  inconsiderable  importance.  It  may,  there- 
fore, be  represented  as  a  lofty  natural  terrace,  backed  by  a  moun- 
tainous wall  on  the  north,  and  open  on  the  south  to  the  full 
influence  of  the  sun,  from  his  rising  to  his  going  down,  during  that 
season  at  least  when  his  influence  is  most  wanted  in  a  northern 
climate. 

Owing  to  its  elevation  above  the  level  of  the  sea,  the  Undercliff 
differs  from  most  of  the  situations  on  our  coast,  in  being  less  exposed 
to  the  direct  and  immediate  influence  of  the  sea  air ;  a  circumstance 
which,  in  a  medical  point  of  view,  deserves  consideration.  Sea  fogs 
are  rare,  except  towards  the  end  of  May  and  during  June,  when 
they  are  more  or  less  prevalent.  Observation  has  proved  that  less 
rain  falls  at  Undercliff  than  on  the  south  coast  generally,  and  even 
than  at  other  parts  of  the  Isle  of  Wight,  a  circumstance  which 
might  have  been  inferred  from  a  consideration  of  the  topographical 
relations  of  the  place.  The  soil,  consisting  chiefly  of  the  detritus 
of  the  sandstone  and  chalk  from  the  incumbent  cliff,  is  naturally 
dry,  and  speedily  regains  its  dryness  after  rain.  The  nature  of  the 
rock,  arid  the  general  shelving  form  of  the  surface,  likewise  con- 
tribute to  render  Undercliff  a  dry  situation. 

The  climate  is  remarkably  equable  as  well  as  mild  and  dry,  and 
there  are  not  many  days  during  the  winter  in  which  the  invalid 
cannot  take  some  exercise  in  the  open  air.  The  mildness  of  the 
climate,  during  the  winter  months,  may  be  in  some  degree  estimated 
by  the  circumstance  of  myrtles,  geraniums,  sweet-scented  verbena, 
heliotropes,  and  other  tender  plants,  usually  withstanding  the  winter 
in  the  open  flower  borders.  The  honey  bee  likewise  continues 
working,  in  ordinary  seasons,  until  after  Christmas. 

To  the  invalid  who  has  cultivated  natural  history,  this  sheltered 
district  possesses  an  additional  advantage.  It  is  rich  in  varied  and 
interesting  plants,  and  the  specimens  of  natural  history,  with  which 
it  abounds,  offer  abundant  inducement  to  exercise  and  mental  oc- 
cupation to  the  cultivators  of  this  delightful  science. 

When  we  consider  the  numerous  local  advantages  of  the  Under- 
cliff, already  detailed,  the  result  of  the  Meteorological  Observations 
appended,  and  take  into  account  the  still  more  conclusive  evidence 
furnished  by  the  condition  of  the  exotic  plants  which  grow  there: 
it  is  evidently  one  of  the  warmest  climates  in  our  island,  and  most 
eligible  for  a  large  class  of  our  delicate  invalids.  With  respect  to 


CLIMATES  OP  ENGLAND.  73 

the  most  decisive  evidence  of  all,  in  a  medical  point  of  view,  I 
mean  the  effects  of  the  climate  on  pulmonary  disease,  my  experience 
is  favourable. 

I  have  certainly  seen  nothing  along  the  South  Coast  that  will 
bear  a  comparison  with  it;  and  Torquay  is,  I  apprehend,  the  only 
place  on  the  Southwest  Coast  which  will  do  so.  But  much  more 
extended  observations  than  we  at  present  possess  for  either  of  these 
places,  are  required  to  determine  their  comparative  merits.  With  a 
temperature  nearly  the  same,  the  climate  of  Torquay  is  soft,  but 
humid  and  relaxing ;  while  that  of  Undercliff  is  dry,  somewhat 
sharp,  and  bracing.  The  winter  temperature  at  these  two  places 
differs  very  little.  Although  at  Torquay  the  temperature  some- 
times rises  higher,  it  likewise  sinks  lower  than  at  Undercliff,  giving 
the  latter  the  advantage  over  it  in  equability  of  temperature.  These 
qualities  peculiar  to  the  two  places  render  them  respectively  suitable 
in  different  diseases,  in  different  forms  of  the  same  disease,  and  in 
constitutions  of  a  different  character.  For  pulmonary  invalids,  the 
best  season  to  be  at  Undercliff  is  from  November  to  May. 

It  is  to  be  regretted,  that  with  all  the  natural  advantages  of  the 
Undercliff,  the  accommodations  are  far  from  what  they  might  have 
been.  Since  the  publication,  however,  of  the  last  edition  of  this 
work,  the  accommodations  for  invalids  have  been  greatly  increased, 
and  although  my  suggestions  have  not  been  strictly  attended  to  in 
the  construction  and  position  of  the  buildings,  they  have  been  so 
in  numerous  instances.  Some  good  houses  have  been  erected  at 
Bonchurch  for  the  accommodation  of  invalids ;  each  house  is  sur- 
rounded by  a  portion  of  ground,  and  care  has  been  taken  to  inter- 
fere as  little  as  possible  with  the  natural  beauties  of  the  place.  The 
little  village  of  Ventnor  is  fast  rising  into  notice  ;  a  handsome  church 
has  been  erected,  some  good  hotels  established,  and  several  houses 
built  for  the  accommodation  of  invalids. 

We  have  now  to  consider  the  advantages  of  the  Isle  of  Wight, 
as  a  summer  residence  for  invalids.  The  Undercliff  itself  affords 
a  mild  summer  climate  ;  but  as  a  change  of  air  and  scene  are 
generally  beneficial  to  the  invalid,  the  summer  months  may  be 
belter  passed  by  many  in  still  cooler  situations  in  other  parts  of  the 
island. 

Niton,  situated  on  the  western  extremity,  but  without  the  limits 
of  Undercliff,  affords  a  cool  summer  residence.  It  has  also  the  ad- 
vantage of  being  in  the  vicinity  of  some  of  the  finest  scenery  on 
the  island,  and  at  no  great  distance  from  the  celebrated  Sand  Rock 
Spring.1 

Cowes  is  likewise  a  good  summer  residence.  The  accommoda- 
tions for  sea  bathing  are  pretty  commodious,  and  it  is  also  cenve- 
niently  situated  for  exercise  on  the  water. 

1  This  powerful  aluminous  chalybeate  source  issues  from  the  cliff,  at  an 
elevation  of  one  hundred  and  thirty  feet  above  the  level  of  the  sea.  It  is 
the  strongest  mineral  water  of  ihe  kind  with  which  we  are  acquainted,  and 
is,  indeed,  too  strong  to  be  drunk  without  large  dilution.  According  to  the 


74  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

The  little  village  of  Sandown,  on  the  eastern  shore,  forms  a 
retired  and  pleasant  summer  residence,  and  is  well  suited  for  sea 
bathing,  having  a  fine  sandy  beach.  Shanklin,  in  the  same  neigh- 
bourhood, is  a  favourite  summer  retreat,  and  one  of  the  prettiest 
places  in  the  island.  But  of  all  the  situations  in  the  island,  Ryde 
appears  to  me  to  deserve  a  preference  as  a  summer  residence.  It 
stands  on  the  slope  of  a  dry,  gravelly  hill,  facing  the  north  ;  imme- 
diately opposite  Portsmouth  ;  and  from  the  fine  open  manner  in 
which  part  of  it  is  built,  many  of  the  houses  having  gardens  at- 
tached to  them,  it  possesses  most  of  the  advantages  of  a  country 
residence,  together  with  those  of  a  sea  bathing  place.  The  neigh- 
bourhood is  also  very  beautiful  and  favourable  for  exercise.  The 
Isle  of  Wight  thus  presents  a  considerable  variety  of  healthy  and 
beautiful  sites,  suited  to  the  wants  of  a  large  proportion  of  valetudi- 
narians. The  proximity  to  the  metropolis,  and  the  rapid  and  easy 
communication  recently  established  by  the  Southampton  railway, 
add  greatly  to  its  conveniences  as  a  residence  for  invalids.1 

CLIMATE  OF  THE  SOUTHWESTERN  COAST. 

The  south  coast  of  Devon  has  a  winter  temperature  nearly  two 
degrees  higher  than  that  of  the  coast  of  Sussex  and  Hampshire, 

analysis  of  the  late  Dr.  Marcet,  a  pint,  or  sixteen  ounces  of  this  water,  con- 
tains the  following  ingredients;  .the  specific  gravity  being  1007.5. 
Of  carbonic  acid  gas,  three  tenths  of  a  cubic  inch. 

Sulphat  of  iron,  in  the  state  of  crystalised  green  sulphat,          41  grs.  4 
Sulphat  of  alumine,  a  quantity  of  which,  if  brought  to  the 

state  of  crystalised  alum,  would  amount  to  ...  31  6 
Sulphat  of  lime,  dried  at  160°  .  .  .  •", :  " '-;. ;  v':^.  10  1 
Sulphat  of  magnesia,  or  Epsom  salts,  crystallised  •  .^  '/  .3  6 
Sulphat  of  soda,  orglauber  salt,  crystallised  $<.*ff.&i:-w,&.:f.  16  0 
Muriat  of  soda,  or  common  salt,  crystallised  ,..„  . '  ^vVi,  .x.^  4  0 
Silica  ....  .*'  '.,,  Vr.  \»'''T4-"v:/^.  ••'  0  7 

107        4 

From  the  resemblance  of  this  spring  to  a  celebrated  mineral  water  in 
Sweden,  Berzelius  was  induced  to  examine  it.  The  results  of  his  experi- 
ments confirmed  the  accuracy  of  Dr.  Marcel's  analysis.  It  has  been  found 
useful  in  the  cure  of  agues,  in  some  cases  of  dyspepsia,  and  in  general  re- 
laxation and  debility  connected  with  uterine  weakness,  &c.  For  a  full  ac- 
count of  the  medical  virtues  of  this  spring,  I  beg  to  refer  to  Dr.  Lempriere's 
little  work  on  the  subject.*  There  is  a  hotel  near  the  spring,  and  I  would 
advise  dyspeptic  invalids  especially,  for  whom  this  water  may  be  prescribed, 
to  drink  it  at  the  source. 

1  In  terminating  my  observations  on  the  climate  of  Undercliff,  I  must  ex- 
press my  obligation  to  Dr.  Martin,  the  resident  physician  in  the  district,  for 
his  able  assistance.  By  continuing  the  series  of  minute  and  careful  obser- 
vations, on  which  he  has  already  been  engaged  some  years,  Dr,  Martin  will 
soon  be  enabled  to  fix  the  character  of  the  climate  of  Undercliff. 


*  Report  on  the  Medicinal  Effects  of  the  Aluminous  Chalybeate  Spring,  lately  dis- 
covered in  the  Jele  of  Wight.     By  William  Lempriere,  M.D.  &c.  &c.    Second  Edition. 


CLIMATES  OP  ENGLAND.  75 

and  from  three  to  four  higher  than  that  of  London.1  The  differ- 
ence is  most  remarkable  during  the  months  of  November,  Decem- 
ber and  January ;  amounting,  on  the  average,  in  the  sheltered 
places,  to  five  degrees  above  London.  In  February,  the  difference 
falls  to  three  degrees,  and  in  March  and  April,  the  excess  of  the 
mean  temperature  over  that  of  London,  does  not  amount  to  one 
degree.  It  ought  also  to  be  remarked,  that  this  difference  takes 
place  principally  in  the  night ;  as  the  difference  between  the  lower 
extremes  of  London  and  the  Southwest  Coast,  is  to  the  difference 
of  the  higher  extremes  as  four  to  three,— a  less  disproportion,  how- 
ever, than  occurs  between  the  South  Coast  and  London.  Hence, 
when  compared  with  the  latter,  the  days  are  proportionally  warmer 
on  the  Southwestern  than  on  the  Southern  Coast ;  whilst  the  nights 
at  these  places  are  nearly  equal.  The  range  of  daily  temperature 
is  about  the  same  on  the  Southwest  and  South  Coasts,  although,  as 
has  been  remarked,  less  than  at  London.  As  regards  the  continu- 
ance of  the  same  temperature,  the  Southwestern  has  a  remarkable 
superiority  over  the  Southern  Coast ;  amounting  nearly  to  three 
fourths  of  a  degree ;  which  is  a  very  considerable  difference,  when 
we  reflect  that  the  whole  amount  of  variation  of  successive  days 
scarcely  exceeds  three  degrees. 

Different  places  on  the  Southwestern  Coast  possess  these  general 
qualities  in  a  more  eminent  degree,  according  as  they  are  more  or 
less  sheltered  from  northerly  and  easterly  winds.  Of  these,  taking 
them  in  succession  from  west  to  east,  Salcombe,  Torquay,  Dawlish, 
Exmouth,  Salterton,  and  Sidrnouth,  deserve  to  be  particularly  no- 
ticed. But  many  other  sheltered  spots  may  be  found  along  this 
coast,  as,  for  instance,  in  the  neighbourhood  of  Plymouth,  at  Kings- 
wear,  near  Dartmouth,  and  other  places.  But  the  great  fault  of 
most  of  these  situations  is,  that  their  climate  is  too  circumscribed  to 
be  of  much  utility  to  the  class  of  invalids  who  are  in  a  condition 
to  derive  the  greatest  advantage  from  a  mild  climate,  I  mean  those 
who  are  capable  of  taking  exercise  in  the  open  air.  At  a  very  little 
distance  from  the  coast,  several  situations  may  be  met  with,  still 
more  completely  protected  from  northeasterly  winds,  than  most  of 
the  places  situated  immediately  on  the  sea  shore.  Among  these 
may  be  mentioned  the  village  of  Lympstone,  about  two  miles  from 
Exmouth,  and  Bishopsteignton,  about  the  same  distance  from 
Teignmouth.  To  this  class  of  situations,  the  village  of  Upton  also 
belongs.  All  these  places,  while  they  are  sufficiently  near  the  coast 

'Notwithstanding  that  public  attention  has  been  so  long  directed  towards 
the  climate  of  Devonshire,  it  is  extraordinary  how  few  are  the  materials 
which  can  be  collected  with  a  reference  to  the  subject.  It  is  to  be  hoped 
that  this  may  not  long  continue  to  afford  a  ground  of  complaint.  We  should 
think  it  an  object  well  worth  the  attention  of  the  scientific  institutions  of 
Exeter,  Plymouth,  Bath,  Bristol,  &c.  Were  they  to  establish  a  series  of  simul- 
taneous observations  at  different  parts  of  the  country  for  a  few  years  only, 
the  character  of  the  climate  of  the  southwestern  part  oi  England  might  be 
accurately  ascertained. 


76  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

to  partake  of  the  mildness  of  its  climate,  are  beyond  the  more  imme- 
diate influence  of  the  sea  air,  and  are  more  protected  from  the 
southerly  gales,  to  which  the  whole  coast  is  exposed.  These  cir- 
cumstances deserve  the  consideration  of  the  physician,  while  weigh- 
ing the  comparative  merits  of  the  two  classes  of  places  as  residences 
for  different  invalids.  The  village  of  Heavitree,  close  to  Exeter, 
although  more  inland,  has  the  credit  of  possessing  a  mild  winter 
climate.  And  this  may  be  true,  as  far  as  regards  the  part  situated 
on  the  southern  aspect  of  the  low  hill  on  which  the  village  is  built; 
but  the  other  parts  are  exposed  to  the  whole  range  of  northeasterly 
winds. 

There  are  other  sheltered  spots  in  the  immediate  vicinity  of 
Exeter,  which  would  afford  mild  winter  residences  for  invalids. 
But  it  will  be  found  that,  as  we  recede  from  the  coast,  the  cold, 
especially  during  the  night,  is  more  intense,  and  the  range  ot  tem- 
perature greater.  And,  independently  of  this  circumstance,  the  few 
accommodations  to  be  found  at  all  these  places,  with  the  exception 
perhaps  of  Heavitree,  prevent  them  from  being  resorted  to  at  present 
by  invalids,  except  in  a  very  limited  degree. 

SALCOMBE. 

This  small  place,  (the  Montpelier  of  Huxham,)  deserves  notice 
here  for  its  remarkable  mildness.  Yet,  although  it  is  perhaps  the 
warmest  spot  on  the  Southwest  Coast,  its  climate  is  limited  to  too 
small  a  space  to  admit  of  Salcombe  ever  becoming  the  resort  of 
invalids  to  any  extent. 

There  is  unfortunately  here  a  want  of  sheltered  ground  for  exer- 
cise ;  and  this  I  hold  to  be  one  of  the  greatest  defects  in  a  winter 
residence,  for  a  large  proportion  of  invalids.  It  is  indeed  chiefly 
for  the  advantage  of  exercise  in  the  open  air,  that  they  leave  the 
comforts  of  their  own  homes.  In  the  immediate  vicinity  of  Sal- 
combe,  there  are  two  beautifully  situated  villas,  Woodville  and  the 
Moult.  At  the  former,  under  the  shelter  of  a  wooded  hill,  the 
American  aloe  has  twice  flowered  in  the  open  air,  and  with  a  degree 
of  luxuriance  almost  equaling  that  which  it  displays  in  a  tropical 
climate.  The  orange  and  lemon  tree,  also,  thrive  here,  and  ripen 
their  fruit  in  the  open  air;  the  only  protection  they  require  during 
the  winter,  being  that  afforded  by  a  covering  of  straw  mat.  These 
trees  exhibit  a  degree  of  luxuriance  and  vigour,  which  I  have  seen 
in  no  other  part  of  England,  under  the  same  circumstances.  The 
olive  tree  has  also  occasionally  produced  fruit  in  this  place. 

TORQUAY. 

The  general  character  of  the  climate  of  the  Southwestern  Coast, 
is  soft  and  humid.  Torquay  is  certainly  drier  than  the  other  places, 
and  almost  entirely  free  from  fogs.  This  drier  state  of  the  atmo- 
sphere probably  arises,  in  part  from  the  limestone  rocks,  which  are 


CLIMATES  OF  ENGLAND.  77 

confined  to  the  neighbourhood  of  this  place,  and  partly  from  its 
position  between  two  streams,  the  Dart  and  the  Teign,  by  which 
the  rain  is  in  some  degree  attracted.  Torquay  is  in  a  great  measure 
protected  from  northeast  winds,  the  great  evil  of  our  spring  climate. 
It  is  likewise  well  sheltered  from  the  northwest,  This  protection 
from  winds,  extends  also  over  a  very  considerable  tract  of  country, 
abounding  in  every  variety  of  landscape,  in  which  the  invalid  may 
find  at  all  times  a  sheltered  spot  for  exercise  either  on  foot  or  horse- 
back. The  beauty  of  the  country  around  Torquay,  and  the  extent 
to  which  it  is  sheltered  from  all  winds,  is  an  advantage  which  it 
possesses  over  all  the  other  places  in  this  district,  and  one  of  great 
importance  to  the  invalid.  It  possesses  all  the  advantages  of  the 
southwestern  climate  in  the  highest  degree.1 

The  village  of  Tor,  situated  immediately  behind,  and  on  the 
high  ground  above  Torquay,  has  been  mentioned  as  a  favourable 
residence  for  invalids.  It  is,  however,  considerably  colder,  and  less 
protected  from  northerly  winds  than  the  latter  place,  and  is  also 
said  to  be  damper.  Just  beyond  Tor  is  the  little  vale  of  Upton, 
which  affords  one  of  the  most  eligible  situations  on  this  coast  for 
establishing  a  Madeira  village;  being  protected  from  southerly  as 
well  as  northerly  winds.  Were  houses  built  along  the  base  of  the 
hills,  which  bound  this  little  vale,  and  the  intervening  space  entirely 
laid  out  in  open  pleasure  grounds  for  exercise,  Upton  would,  I  be- 
lieve, form  one  of  the  most  favourable  winter  residences  for  invalids 
in  Devonshire. 

DAWLISH. 

Of  the  places  on  this  coast,  frequented  by  invalids  during  the 
winter,  Dawlish  appears  to  me  to  deserve  the  preference,  after  Tor- 
quay. Although  less  dry  than  the  latter  place,  it  is  perhaps  drier 
than  the  other  parts  of  the  coast.  Dawlish  is  well  protected  from 
northerly  winds,  and  also  from  the  violence  of  the  southwesterly 
gales.  It  is  less  protected  from  east  winds,  and  this  is  more  espe- 
cially the  case  with  the  part  of  the  town  situated  near  the  beach; 
indeed,  this  is  much  exposed  to  easterly  winds.  The  part  more 
distant  from  the  sea  is  better  protected ;  and  there  are  also  some 
well  sheltered  walks  in  this  quarter.  But  Dawlish  is  altogether 
upon  a  small  scale,  and  its  confined  situation  must,  I  should  think, 
render  the  air  close  and  somewhat  oppressive  to  many  invalids,  in 
calm,  mild  weather. 

EXMOUTH— SALTERTON. 

Part  of  Exmouth  stands  high,  and  is  exposed  to  almost  every 
wind,  more  especially  to  the  southwesterly  gales.  The  lower  parts 

1  For  a  full  and  interesting  account  of  the  country  the  reader  is  referred  to 
the  Panorama  of  Torquay,  &c.  by  Octavian  Blewit,  Esq. 


78  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

of  the  town  are  protected  from  these,  and,  in  a  considerable  degree 
also,  from  northerly  winds.  The  situation  of  this  part  of  the  town, 
with  respect  to  the  river,  exposes  it,  however,  to  occasional  damp, 
as  it  did  formerly  to  inundations  from  the  sea  in  severe  storms,  with 
high  tides.  This  latter  inconvenience  has  been  lately  obviated  by 
means  of  an  embankment,  which  excludes  the  sea,  and  has  thus 
allowed  about  sixty  acres  of  what  were  formerly  banks  of  mud  to 
be  converted  into  green  meadows.  There  is  here  also  a  want  of 
sheltered  ground  for  exercise,  and  the  place  altogether  does  not  ap- 
pear to  possess  great  advantages  as  a  winter  residence  for  delicate 
invalids,  more  especially  for  those  labouring  under  pulmonary 
affections.  Exmouth  is,  however,  a  healthy  place ;  and  1  may 
remark  here,  that,  notwithstanding  the  whole  of  this  coast  is  rather 
humid,  agues  are  almost  unknown,  as  far  as  I  could  learn.  A  little 
way  in  the  interior,  they  are  not  uncommon.  Although  Exmouth 
is  not  well  suited  for  persons  with  delicate  chests,  other  invalids 
often  experience  great  benefit  from  a  residence  there,  more  particu- 
larly on  the  Beacon  Hill,  the  most  elevated  and  finest  situation  in 
the  place;  and  which,  as  some  compensation  for  the  buffetings  of 
the  southwest  gales,  commands  one  of  the  most  magnificent  views 
in  Devonshire.  Along  the  southern  base  of  this  hill,  there  is  also 
a  road  of  considerable  extent,  protected  from  north  and  northeast 
winds,  and  well  suited  for  exercise  during  the  prevalence  of  these. 
Salterton. — This  village,  about  four  miles  to  the  eastward  of 
Exmouth,  presents  advantages  in  point  of  situation  which  render 
it  preferable  to  the  latter  place  as  a  winter  abode  for  the  invalid.  It 
stands  in  a  small  open  valley  on  the  sea  shore,  well  protected  from 
winds, — particularly  northerly  winds. 

SIDMOUTH. 

This  place  is  situated  on  the  sea  beach,  at  the  mouth  of  an  open 
valley,  through  which  the  little  river  Sid  runs ;  and  would  be  fully 
exposed  to  northerly  winds  from  the  mountains,  whence  this  stream 
takes  its  rise,  but  for  the  profusion  of  lofty  and  luxuriant  elms  and 
other  trees,  which  shelter  it  partially  in  that  quarter.  Some  of  the 
houses  at  a  little  distance  from  the  sea-beach  are  tolerably  well  pro- 
tected from  northerly  winds ;  whilst  Peak  Hill  and  Salcombe  Hill 
give  protection  in  a  considerable  degree  from  westerly  and  easterly 
winds.  Sidmouth  seems  well  calculated  for  a  summer  and  autumn 
bathing  place;  and,  in  the  more  sheltered  situations  mentioned,  the 
invalid  may  find  a  suitable  abode  during  the  winter.  The  climate 
is  damp,  and  in  November,  is  subject  to  sea-fogs,  which  is  also  said 
to  be  the  case  with  Exmouth. 

In  one  or  other  of  these  places,  the  invalid  may  obtain  all  the 
benefit  which  a  residence  during  the  winter  on  the  South  Coast  of 
Devon  affords. 

The  influence  of  the  southwestern  climate  on  disease  may  be 
anticipated,  in  a  great  degree,  from  its  physical  characters,  which 


CLIMATES  OF  ENGLAND,  79 

we  have  shown  to  be  mild  but  rather  humid,  consequently  soothing 
but  rather  relaxing.  In  one  class  of  complaints,  it  is,  therefore, 
calculated  to  prove  decidedly  beneficial, — in  another,  of  an  opposite 
character,  equally  injurious. 

Pulmonary  diseases  are  those  in  which  the  climate  has  been  con- 
sidered especially  beneficial.  But  as  there  is  considerable  variety 
in  the  character  of  the  different  diseases  to  which  the  lungs  are 
liable,  as  well  as  in  that  of  the  different  constitutions  in  which  they 
occur,  so  will  the  benefit  to  be  derived  from  this  climate  depend 
upon  its  being  applied  to  the  proper  cases.  In  chronic  inflammatory 
affections  of  the  throat,  trachea  and  bronchi,  attended  with  a  dry 
cough,  or  with  little  expectoration,  decided  benefit  may  be  expected. 
But  when  there  exists  in  such  cases  a  relaxed  state  of  the  mucous 
surfaces  with  copious  expectorations,  especially  when  occurring  in 
a  languid  and  relaxed  constitution,  the  disease  is  more  likely  to  be 
aggravated  than  diminished  by  a  residence  on  this  coast.  From 
this  statement  will  be  understood  the  character  of  the  more  serious 
diseases  of  the  chest,  which  are  likely  to  be  relieved  by  this  climate. 

In  gastritic  dyspepsia,  it  is  serviceable ;  likewise  in  dysmenorrhoea, 
and  the  various  nervous  symptoms  consequent  upon  it.  On  the 
other  hand,  this  climate  certainly  exerts  an  unfavourable  influence 
on  all  nervous  complaints  arising  from  relaxation  or  want  of  tone  of 
the  nervous  system;  on  persons  subject  to  nervous  headaches ;  and 
in  the  purer  forms  of  atonic  dyspepsia,  more  especially  when  accom- 
panied with  a  languid,  relaxed  state  of  constitution.  Indeed,  this 
form  of  dyspepsia  is  one  of  the  most  common  complaints  among  the 
inhabitants  of  the  coast;  and  it  frequently  happens  that  persons, 
who  have  come  from  a  colder  and  more  bracing  part  of  the  country 
to  reside  here,  suffer  much  from  this  disease. 

This  climate  will  be  found  no  less  unfavourable  to  persons  sub- 
ject to  menorrhagia  and  leucorrhoaa,  and  in  all  diseases  of  the 
mucous  membranes,  attended  with  a  relaxed  state  of  the  system,  or 
with  much  discharge  from  the  affected  organs.  In  recommending 
a  residence  on  this  coast  to  invalids,  it  is  absolutely  necessary  to 
attend  to  these  distinctions,  respecting  the  nature  of  their  diseases 
and  the  character  of  their  constitutions,  otherwise  frequent  disap- 
pointments must  be  the  consequence. 

What  maybe  the  real  estimation  in  which  the  climate  of  Devon- 
shire ought  to  be  held  in  consumptive  complaints,  and  what  may 
be  its  absolute  effect  upon  these,  I  have  much  difficulty  in  saying: 
but  this  much  I  may  venture  to  advance,  that  as  the  invalid  will  be 
exposed  to  less  rigorous  cold,  and  for  a  shorter  season, — will  have 
more  hours  of  fine  weather,  and,  consequently,  more  exercise  in  the 
open  air, — he  gives  himself  a  better  chance  by  passing  the  winter 
here,  than  in  the  more  northern  parts  of  the  island.  To  compare 
it,  also,  in  this  respect,  with  the  milder  climates  of  the  South  of 
Europe,  is  no  easy  task.  In  the  south,  the  invalid  has  finer  days, 
a  drier  air,  and  more  constant  weather ;  but  the  transitions  of  tem- 
perature, though  less  frequent,  are  more  considerable.  In  the 


80  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

nights,  I  believe,  invalids  are  often  exposed  to  severer  cold  than 
here;. and  this  arises  partly  from  the  great  range  of  temperature, 
and  partly  from  the  imperfect  manner  they  are  protected  from  the 
cold  of  night,  by  the  bad  arrangement  of  the  houses,  chimnies,  &c. 
To  afford  an  opportunity  of  judging  of  the  proper  value  of  this  last 
circumstance,  I  subjoin  a  comparison  of  temperature  in-doors  and 
out-of-doors,  from  observations  made  by  the  same  invalid  (a  correct 
and  careful  observer)  at  Nice  and  Torquay.1 

From  the  soft  nature  of  the  climate  of  this  coast,  and  the  relax- 
ing and  enervating  effects  which  a  long  residence  on  it  is  liable  to 
produce  on  many  constitutions,  invalids  who  mean  to  reside  here 
during  several  winters,  should  leave  it  in  the  summer,  and  seek  a 
drier  and  more  bracing  air.  Such  as  are  unwilling,  or  unable,  to 
undertake  a  long  journey,  should  retire  to  some  of  the  drier  and 
more  elevated  places  at  a  little  distance  from  the  coast.  Among 
these,  Chudleigh  deserves  to  be  particularly  noticed.  It  is  finely 
situated  on  a  ridge  of  limestone  rock,  beyond  the  range  of  the  Hal- 
don  hills,  and  about  five  miles  from  the  coast,  and  is  esteemed  one 
of  the  driest  and  most  healthy  sites  in  this  part  of  the  country.  A 
more  inland  situation,  and,  from  its  vicinity  to  Dartmoor,  possessing 
a  still  more  bracing  air  than  Chudleigh,  is  Moreton  Hamstead  ;  and 
this  place,  if  suitable  accommodations  were  to  be  found,  would  be  a 
good  summer  quarter  for  invalids  under  the  circumstances  alluded 
to.  llfracombe  and  Linton,  on  the  northern  coast  of  Devon,  and 
other  places  in  that  beautiful  and  romantic  region,  afford  excellent 
summer  residences  for  some  invalids.  One  objection  to  such  a 
migration,  which  formerly  existed  in  the  badness  of  the  roads,  is 
now  remedied  by  the  formation  of  a  new  level  line  of  road  from 
Exeter  to  Barnstaple  and  llfracombe. 

There  is  as  marked  a  difference  between  the  summer  climate  of 
North  and  South  Devon,  as  there  is  between  the  cast  of  their  scenery ; 
the  air  of  the  former  being  keen  and  bracing,  and  its  features  roman- 
tic and  picturesque,  while  in  the  latter,  the  rich  softness  of  the  land- 
scape harmonises  with  the  soft  and  soothing  qualities  of  the  climate. 

CLIMATE    OF    CORNWALL. 

The  climate  of  the  South  Coast  of  Cornwall,  in  its  general  cha- 
racters, as  also  in  its  influence  on  disease,  resembles  closely  that  of 
the  South  Coast  of  Devon,  and  has  also  long  been  resorted  to  by 
pulmonary  invalids. 

PENZANCE. 

Penzance,  as  the  chief  residence  of  invalids  in  Cornwall  during 
the  winter,  claims  a  particular  notice;  it  is  situated  on  the  shore  of 
the  beautiful  Mounts-  Bay ',  about  ten  miles  from  the  extreme  western 

1  Appendix. 


CLIMATES  OP  ENGLAND.  81 

point  of  England,  termed  the  Land's-end.  Although  situated  on  the 
shore  of  a  bay  surrounded  by  high  land,  Penzance  can  hardly  be 
said  to  be  sheltered  from  any  wind;  it  therefore  exhibits,  in  its 
meteorological  results,  the  common  features  of  the  district  in  which 
it  lies.  Dr.  Forbes  was  the  first  to  point  out  the  character  of  this 
climate ;  and  it  would  have  spared  me  much  trouble  and  time,  had 
I  had  the  facility  afforded  me,  in  inquiring  into  other  climates,  for 
which  we  are  indebted  to  Dr.  Forbes  in  regard  to  this.  A  few  such 
analyses,  as  his  "  Observations"  present,  would  soon  make  the  pro- 
blem of  the  climate  of  this  country,  as  regards  all  useful  purposes, 
cease  to  be  a  desideratum.1 

The  mean  annual  temperature  of  Penzance  is  52°. 16,  being  only 
1°.77  above  that  of  London,  But  the  temperature  is  very  differently 
distributed  over  the  year  at  the  two  places.  Although  Penzance  is 
only  a  degree  and  a  half  warmer  than  London  for  the  whole  year, 
it  is  5^°  warmer  in  winter;  2°"  colder  in  summer;  scarcely  1° 
warmer  in  the  spring;  and  only  about  2£°  warmer  in  the  autumn. 

As  regards  the  temperature  of  the  different  months,  relatively 
with  London,  the  greatest  difference  occurs  in  the  following  order, 
, — December,  January,  November  and  February.  In  April,  the 
difference  is  reduced  to  half  a  degree  ;  in  May,  Penzance  is  1°  and 
in  July,  2|°  colder  than  in  London ;  and  the  temperature  does  not 
again  rise  above  that  of  London  until  the  month  of  October.  So 
that  were  one  to  give  a  graphical  term  of  expression  for  the  pro- 
gression of  the  mean  temperature  of  the  two  places  through  the 
year,  that  of  London  would  more  resemble  an  ellipsis,  and  that  of 
Penzance  the  more  equal  figure  of  a  circle.  This  will  be  aptly 
illustrated  by  observing,  that  the  difference  between  the  mean  tem- 
perature of  the  warmest  and  coldest  months  in  London  is  26°, 
while  at  Penzance  it  is  only  18°;  and  that,  whilst  in  London  the 
mean  difference  of  the  temperature  of  successive  months  is  4°.36,  it 
is  only  3°  at  Penzance.  On  examining  the  progression  of  tempera- 
ture for  the  twenty-four  hours  at  these  two  places,  we  find  that,  in 
winter,  it  is  during  the  night  that  the  greater  part  of  this  difference 
of  temperature  occurs ;  Penzance  being  nearly,  on  an  average,  six 
degrees  and  a  half  warmer  than  London  during  the  night ;  and 
only  little  more  than  three  degrees  warmer  during  the  day.  But 
this  equal  distribution  of  heat  throughout  the  year  at  Penzance, 
which  we  have  compared  so  advantageously  with  that  of  London, 
is  still  more  striking  when  compared  with  that  of  the  South  of 
Europe.  Madeira  and  the  Azores  are  the  only  climates  which  we 
have  examined  that  are  superior  to  Penzance  in  this  quality. 

The  same  remarkable  equality  in  the  distribution  of  temperature 
during  the  year  at  Penzance,  holds  equally  true  for  the  day  ;2  and, 

'Observations  on  the  Climate  of  Penzance  and  the  District  of  the  Land's- 
end.  By  John  Forbes,  M.  D. 

2  Thus  in  the  winter  of  1827-8,  the  mean  daily  range  at  Penzance  was 
7°.50;  at  London,  at  Gosport,  Torquay,  and  Nice,  it  was  12°,  10°,  11°,  and 
11°  respectively. 

1— f  6  dark 


82  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

indeed,  I  may  observe  generally,  that  the  progression  of  tempera- 
ture for  the  year  and  the  day,  are  faithful  types  of  each  other.  I 
find,  on  comparing  the  months  for  a  series  of  years,  that  the  daily 
range  at  Penzance  is  little  more  than  half  that  of  the  South  of 
Europe;  but  in  this  quality,  it  also  falls  short  of  Madeira.  And 
here  is  a  proper  opportunity  of  remarking,  that  although  in  mean 
temperature  for  the  whole  twenty-four  hours,  Penzance  is  consi- 
derably lower  than  that  of  the  South  of  Europe,  yet  that  during  the 
night,  through  the  winter,  its  extreme  minimum  temperature  sel- 
dom is  so  low.  It  is  during  the  day,  only,  that  the  South  of  Europe, 
as  far  as  regards  temperature  simply,  possesses  a  superiority.  Thus, 
in  winter,  at  seven  o'clock  in  the  morning,  there  is  little  difference 
between  Rome  and  Penzance,  but  at  two  o'clock  in  the  afternoon, 
there  is  nearly  the  difference  of  7°.  Indeed  the  whole  advantage  of 
Penzance,  as  compared  with  the  South  of  Europe,  appears  to  occur 
in  the  winter  and  during  the  night. 

In  the  duration  of  the  same  temperature,  as  shown  by  the  mean 
variation  of  successive  days,  the  climate  of  Penzance  excels  all  the 
northern  climates,  and  nearly  equals  Rome  and  Nice  in  this  respect. 

As  will  have  been  observed,  Penzance  loses,  in  the  spring,  its 
superiority  of  climate.  In  April  and  May,  it  appears  decidedly  in- 
ferior to  the  more  sheltered  spots  on  the  South  Coast  of  Devon, 
and  to  Undercliff,  and  very  much  so  to  the  Southwest  of  France. 
For  instance,  at  Pan,  the  mean  temperature  during  the  winter  is 
nearly  3°  below  that  of  Penzance,  while  during  the  spring  it  is  5° 
above  it. 

In  the  other  elements  of  climate,  this  district  has  less  peculiar 
advantages.  There  falls  at  Penzance  about  twice  as  much  rain  as 
at  London.  The  number  of  days  on  which  rain  falls,  does  not, 
however,  seem  in  proportion  to  the  quantity  of  fluid  precipitated. 
Mr.  Giddy  makes  the  average  number  of  wet  days,  during  seven 
years,  177.3,  and  he  particularly  states,  that  under  this  head  he 
comprehends  "  rainy,  showery,  and  misty  days, — in  short,  all  days 
on  which  there  is  any  fall  whatever,  even  a  slight  shower."  The 
average  number  of  wet  days  at  London  is  178,  being  almost  pre- 
cisely the  same  as  that  recorded  by  Mr.  Giddy  for  Penzance.  Of 
the  much  greater  humidity  of  the  atmosphere  in  Cornwall,  how- 
ever, there  can  be  no  doubt.  The  testimony  of  Dr.  Forbes,  who 
had  ample  means  of  forming  a  correct  judgment,  is  very  strong  on 
this  point.  Another  of  the  disadvantages  of  the  climate  of  the  south- 
western extremity  of  our  island,  is  its  liability  to  violent  and  fre- 
quent gales  of  wind,  and  of  this  disadvantage  Penzance  appears  to 
partake  largely. 

The  effects  of  the  southerly  winds  is  to  raise  the  temperature 
greatly,  especially  during  the  night.  "  During  the  prevalence  of 
the  south  or  southwest  gales,"  says  Dr.  Forbes,  "  there  is  very  little 
difference  of  temperature  between  the  day  and  night,  as  proved  by 
the  register  thermometer.  Sometimes  there  is  no  difference  what- 
ever; and  very  commonly  the  minimum  of  the  night  is  not  more 


CLIMATES  OF  ENGLAND.  83 

than  3°  or  4°  below  the  maximum  of  the  day.  This  shows  how 
very  completely  the  influence  of  the  sun  is  excluded  by  the  dense 
vapour  with  which  the  air  is  loaded;  and  during  these  our  moist 
siroccos,  we  may  say,  without  any  metaphor,  that  we  are  breathing 
the  breezes  of  a  climate  milder  than  our  own.  When  these  south 
and  southwest  winds,  so  prevalent  in  winter,  are  very  gentle,  the 
sky  is  often  clear  for  many  days  together.  On  these  occasions,  the 
warmth  and  softness  of  the  air  are  truly  delightful ;  and  when 
taken  in  conjunction  with  the  beautiful  scenery  around  Penzance, — 
the  calm  blue  bay, — the  gay  green  meadows, — the  myrtles,  and 
other  exotic  plants  common  in  our  shrubberies, — one  is  almost 
tempted  to  forget  that  it  is  winter  landscape  that  he  is  contem- 
plating."1 

It  is  principally  in  consequence  of  its  exposure  to  the  northeast 
during  the  spring  months,  that  Penzance  is  absolutely  colder  than 
the  coast  of  Devonshire,  or  even  the  neighbourhood  of  Bristol, 
during  this  season.  This  circumstance  of  exposure  to,  or  shelter 
from  cold  winds,  constitutes  the  principal  cause  of  the  difference  of 
different  places,  in  the  same  line  of  climate,  in  point  of  warmth  as 
experienced  by  man ;  for  the  influence  of  temperature  on  the  living 
body  is  indicated  much  more  accurately  by  our  sensation  than  by 
the  thermometer.  Unless,  therefore,  the  indications  of  the  thermo- 
meter are  corrected  by  observing  the  winds,  we  shall  form  very 
erroneous  ideas  of  the  climate  of  many  places. 

The  only  other  place  in  this  district  that  deserves  particular 
notice  is  Falmouth,  including  the  neighbouring  village  of  Flush- 
ing. The  winter  temperature  of  Falmonth  (which  lies  about  thirty 
miles  to  the  east  of  Penzance)  is  a  trifle  lower  than  that  of  the  latter 
place,  but  the  general  qualities  of  its  climate  are  nearly  the  same. 
In  one  respect,  indeed,  the  village  of  Flushing,  which  is  situated 
on  the  east  side  of  the  river  Fal,  (Falmouth  being  on  the  west,)  has 
the  advantage  of  Penzance,  being  much  better  sheltered  from  the 
east  winds  by  the  hills  which  rise  immediately  above  it,  and  if  it 
possessed  good  accommodations,  erected  in  the  best  situation,  this 
village  would  form  a  residence  for  invalids,  during  the  spring 
months,  superior  to  Penzance.  Like  many  other  places,  however, 
favourably  circumstanced  as  to  shelter  by  hills,  the  local  climate  of 
Flushing  is  much  too  limited,  from  a  deficiency  of  protected  ground 
for  exercise. 

The  disadvantages  which  attach  to  the  climate  of  the  Land's-end 
generally,  in  point  of  humidity  and  exposure  to  winds,  are  such,  as 
in  a  great  measure  to  neutralise  the  superiority  which  it  possesses 
over  the  other  climates  of  England  in  mildness  and  equability  of 
temperature.  In  its  general  characters,  this  climate  resembles  so 
closely  that  of  the  south  coast  of  Devonshire,  that  the  remarks 
already  made  on  the  influence  of  the  latter  on  disease,  apply  nearly 
to  it.  The  climate  of  the  southwest  of  Cornwall  is  still  more  relax- 

1  Op.  citat. 

6* 


84  CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

ing  than  that  of  the  south  of  Devon.  Disorders,  commonly  termed 
nervous  and  stomach  complaints,  are  unusually  frequent  among 
the  lower  classes.  Diseases  of  the  osseous  system, — of  the  spine 
and  large  joints  (mostly  of  a  scrofulous  character,)  are  also  very 
common.  Although  not  a  strong  race  of  people,  the  inhabitants  of 
this  district  are,  however,  long  lived. 

Regarding  the  influence  of  this  climate  on  consumption,  we  have 
the  testimony  of  Dr.  Forbes,  founded  on  ample  experience,  that  little 
is  to  be  expected  from  it ;  but  we  ought  to  admit,  at  the  same  time, 
that,  in  this  respect,  it  but  shares  the  opprobrium  with  every  other 
climate,  in  the  advanced  stages  of  that  disease.  "  In  a  good  many 
cases,  however,  of  chronic  bronchitis,  simulating  phthisis,  the  health 
was  greatly  improved,  and  in  some  it  was  completely  restored,  from 
a  state  of  great  debility  and  seeming  danger.  In  a  few  cases,  also, 
of  young  persons  who  accompanied  their  diseased  relatives,  and  in 
whom  the  hereditary  predisposition  was  strongly  marked,  if  there 
was  not  already  evidence  of  nascent  tubercles, — a  great  and  striking 
improvement  in  the  general  health  and  strength  followed  within  a 
short  period  after  their  arrival,  and  seemed  fairly  attributable  to  the 
combined  influence  of  change  of  air,  scene  and  habits."1 

The  consumptive  cases  in  which  the  soft  humid  atmosphere  of 
this  place  is  likely  to  prove  beneficial,  are  those  in  which  the  dis- 
ease is  accompanied  with  an  irritated  state  of  the  mucous  membrane 
of  the  lungs,  producing  a  dry  cough,  or  one  with  little  expectoration. 

In  idiopathic  tracheal  and  bronchial  diseases  of  the  same  charac- 
ter, whether  complicated  with  asthma,  or  otherwise,  and  also  in 
certain  pure  cases  of  the  latter  disease,  it  is  likely  to  be  very  bene- 
ficial. When,  on  the  contrary,  there  exists  a  relaxed  state  of  the 
system,  or  a  disposition  to  copious  secretion  from  the  bronchial 
membrane,  whether  idiopathic,  or  symptomatic  of  a  tuberculous 
state  of  the  lungs,  or  where  haemoptysis  has  occurred,  I  believe  the 
climate  of  the  Land's-end  will  generally  prove  injurious. 

As  a  summer  residence  for  invalids,  and  also  as  a  residence  dur- 
ing the  whole  year,  the  district  of  the  Land's-end  is,  perhaps,  equal 
to  the  coast  of  Devonshire.  In  the  winter,  however,  and  still  more 
in  the  spring,  the  latter  will,  I  believe,  in  most  cases  deserve  a  pre- 
ference. If  Penzance  is  somewhat  warmer  and  more  equable  in  its 
temperature,  it  is  more  humid  and  more  exposed  to  storms  during 
the  winter,  while  it  is  rather  colder,  and  less  protected  from  the 
northeast  winds  during  the  spring.  Aged  invalids,  with  whom,  in 
general,  a  soft  climate  agrees,  and  to  whom  even  a  moderate  degree 
of  humidity  is  not  objectionable,  might  more  particularly  derive 
benefit  by  residing  during  the  whole  year  at  Penzance.  The  great 
mildness  of  the  winter  would  enable  them  to  be  much  in  the  open 
air,  arid  they  would  have  less  to  dread  from  the  coldness  of  the 
nights  than  in  any  other  part  of  England. 

*Dr.  Forbes's  translation  of  Laennec's  Treatise  on  Diseases  of  the  Chest. 
Note  by  translator,  3d  Edit.  p.  73. 


CLIMATES  OF  ENGLAND.  85 

The  country  around  Penzance  is  healthy,  and  affords  a  great 
variety  of  excellent  rides  and  drives.  Accommodations  for  invalids 
are  numerous;  and  being  a  sea-port,  the  place  affords  convenience 
for  water  exercise  during  the  summer.  Invalids  who  have  passed 
the  winter  at  Penzance,  and  whose  complaints  are  likely  to  be 
aggravated  by  the  spring  winds,  might  remove  to  Flushing  or 
Fowey  at  that  season ;  and  some  might  even  go  to  Clifton  with 
advantage.1 

WEST    OF    ENGLAND. 

The  mean  temperature  of  the  Western  Group  of  climates  dur- 
ing the  winter  is  rather  lower  than  that  of  the  South  Coast,  but  in 
March  and  April  rises  a  little  higher.  Bath  and  Bristol,  during  the 
months  of  November  and  December,  are  nearly  3°  warmer  than 
London.  In  January  and  February  they  do  not  average  1°  warmer ; 
in  March,  Bath  and  Cheltenham  are  rather  colder  than  London,  but 
Bristol  continues  from  one  to  two  degrees  warmer  during  March  as 
.well  as  April.  On  comparing  Penzance  with  this  tract,  we  find 
only  1°  of  difference  in  the  mean  annual  temperature.  In  winter, 
however,  Penzance  is  4°  warmer ;  but  in  the  spring  and  summer 
it  is  somewhat  colder.  The  distribution  of  heat  throughout 
the  year,  is  more  unequal  in  this  district  than  in  the  others ;  the 
difference  of  the  warmest  and  coldest  months  being  28°,  while  it  is 
only  26°  at  London,  21°  at  Gosport,  20°  at  Torquay,  and  18°  at 
Penzance.  We  find,  also,  that  the  range  of  temperature  for  the  day 
and  the  month  is  considerably  more  than  on  the  Southern  and 
Southwestern  coasts,  and  the  Land's-end ;  the  minimum  term  of 
temperature  being  from  3°  to  5°,  and  even  to  6°  lower  than  at  some 
of  these  places.  In  steadiness  of  temperature  from  day  to  day,  it 
nearly  corresponds  with  the  South  Coast,  but  is  inferior  to  that  of 
South-Devon,  and  considerably  so  to  Penzance. 

CLIFTON. 

In  this  tract  of  country  the  vale  of  Bristol  appears  to  be  the 
mildest  and  most  sheltered  spot.  The  climate,  during  the  winter, 
is  mitigated  by  the  vicinity  of  the  great  western  ocean,  while  its 
land-locked  situation  protects  it  from  the  winds  of  that  quarter. 
To  those  from  the  southeast  it  is  fully  open.  The  fall  of  rain  in 
this  district  is  less  than  from  its  western  position  might  have  been 
expected.  The  mountain  ranges  which  flank  the  country  border- 
ing the  Bristol  channel, — those  of  Wales  on  the  north,  and  those  of 

1  For  much  interesting  information  respecting  the  natural  history  and  anti- 
quities of  this  district,  I  refer  the  reader  to  Dr.  Forbes's  tract,  already  referred 
to,  and  to  his  more  recent  and  admirable  essay  on  the  Medical  Topography 
of  the  Lands-end,  in  the  Provincial  Medical  Transactions,  vol.  ii. ;  also  to 
an  amusing  little  work,  entitled,  "  A  Guide  to  Penzance  and  the  Lands- 
end,"  written,  it  is  said,  by  an  eminent  physician  now  resident  in  London. 


86  CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

Cornwall  and  Devonshire  on  the  south,  by  modifying  the  course  of 
the  clouds  from  the  Atlantic,  appear  to  diminish  the  fall  of  rain  in 
the  intervening  space.  There  is  reason  to  believe  also  that  this  is 
even  less  at  Bristol  than  the  average  of  the  surrounding  district,  a 
circumstance  which  may  be  accounted  for,  partly  by  its  protection 
from  westerly  winds,  and  partly  from  its  position  with  respect  to 
the  course  of  the  Severn  and  its  extensive  estuary ;  from  the  nearest 
part  of  which  Bristol  is  distant  about  five  miles,  and  is,  at  the  same 
time,  completely  shut  out  from  it  by  the  intervening  high  land. 
But  however  the  circumstance  may  be  explained,  the  fall  of  rain  is 
absolutely  less  here  than  in  Devonshire  and  Cornwall,  and  much 
the  same  as  that  on  the  south  coast.1 

The  surrounding  hills  are  composed  chiefly  of  limestone,  and 
this  circumstance  tends  further  to  diminish  the  humidity  of  the 
atmosphere. 

Clifton  and  its  immediate  neighbourhood,  afford  a  considerable 
variety  in  point  of  shelter  and  elevation  of  site.  The  town  is  built 
on  the  southern  declivity  of  a  hill,  at  the  bottom  of  which  is  situated 
the  Bristol  Hotwells.  Here,  and  in  the  lower  parts  of  Clifton,  the 
most  sheltered  situations  are  to  be  found.  And,  accordingly,  con- 
sumptive and  other  delicate  invalids  should  seek  the  more  protected 
spots  in  this  quarter  during  the  winter:  while  those  requiring  less 
shelter  may  reside  on  the  higher  but  still  sheltered  parts  of  Clifton. 
The  crescentic  forms  of  the  buildings  in  this  place  are  singularly 
well  adapted  to  the  situation,  as  they  afford  protection  to  so  many 
terraces,  well  suited  for  exercise  during  the  prevalence  of  northerly 
winds.  In  the  lower  grounds  there  are  also  some  sheltered  walks, 
and  towards  the  park  several  rides  and  foot  paths  which  are  tolerably 
defended  from  northerly  winds.  But,  in  this  respect,  Clifton,  during 
the  cold 'season,  does  not  afford  great  variety.  When,  however,  the 
weather  is  sufficiently  mild  to  admit  of  the  invalid  going  to  some 
little  distance  from  home,  few  places  present  more  beauty  or  variety. 
The  whole  parish  of  Clifton  is  indeed  well  described  by  the  late  Dr. 
Chisholm,  as  "  a  beautiful  and  romantic  assemblage  of  woods,  rock, 
water,  pasture  and  down.  It  seems  indeed  singularly  well  adapted 
to  the  maintenance  of  health ;  the  soil  resting  on  immense  beds  of 
limestone  rock,  exposed  to  the  southerly  and  westerly  winds,  for 
nearly  three  fourths  of  the  year  ;  with  an  atmosphere  elastic,  vivify-- 
ing— not  humid.'72  The  surrounding  country  is  healthy,  being  free 

1  The  average  fall  of  rain  for  six  years  at  Bristol,  as  given  by  Dr.  Cole,  is 
31  inches.  Penzance  44.  London  25.  There  is  reason  to  believe,  however, 
that  31  inches  is  above  the  average  fall.  Dr.  Carrick  makes  the  mean  often 
years,  JSOi  to  1810,  only  24  inches;  and  the  accuracy  of  Dr.  Carrick's  ob- 
servation is  supported  by  those  of  Col.  Cupper,  which  give  a  mean  of  23.76 
for  eight  years  (1800  to  1807)  at  Cardiff.— See  his  Meteorological  and  Mis- 
cellaneous Tracts. 

*  See  an  excellent  paper,  by  this  amiable  and  enlightened  physician,  on 
the  Statistical  Pathology  of  Bristol  and  of  Clifton,  in  the  Ed.  Med.  and 
jSurg.  Journal,  vol.  xiii.  1817. 


CLIMATES  OF  ENGLAND.  87 

from  every  thing  like  marsh.  Dr.  C.  informs  us  that  in  the  list  of 
diseases  admitted,  during  four  years,  into  the  Clifton  dispensary, 
only  one  case  of  intermittent  fever  appeared,  and  that  one  was  from 
the  fenny  district  near  Congresbury,  about  twelve  miles  to  the  west- 
ward of  Clifton. 

As  far,  then,  as  we  are  enabled  to  judge  respecting  this  climate, 
from  the  obvious  local  advantages  which  it  possesses,  in  point  of 
shelter  and  aspect,  and  from  the  evidence  afforded  by  meteorological 
registers,  the  vicinity  of  Bristol  and  Clifton  appears  to  be  the  mildest 
and  driest  climate  in  the  west  of  England,  and  consequently  the  best 
winter  residence,  in  that  part  of  the  country,  for  invalids. 

Compared  with  the  South  and  Southwest  Coasts,  the  spring  is 
the  period  of  the  year  during  which  this  climate  appears  to  the 
greatest  advantage.  This  season,  as  we  have  already  seen,  is 
warmer  here  than  on  the  South  Coast,  (with  the  exception  of 
Undercliff,)  whilst  it  is  equal  to  that  of  the  warmer  parts  of  the 
Southwest  Coast.  When  the  climate  of  Clifton  is  compared  more 
closely  with  that  of  Devonshire,  it  may  be  characterised  as  drier 
and  more  bracing  than  the  latter,  arid  as  more  exciting  to  most 
consumptive  patients,  and  to  those  labouring  under  irritable  affec- 
tions of  the  bronchial  membrane.  For  such  cases,  the  softer  and 
more  humid  air  of  Devon  will  be  found  more  soothing ;  while  for 
invalids,  whose  constitutions  have  suffered  from  long  continued 
derangement  of  the  digestive  organs,  or  a  congested  state  of  the 
mucous  membranes  with  copious  secretion,  and  also  for  young 
scrofulous  persons,  and  those  of  relaxed  habits  of  body  generally, 
Clifton  will  prove  a  preferable  climate.  And  this  gives  me  an 
opportunity  of  repeating,  that  in  comparing  climates  together,  as 
regards  their  influence  on  diseases,  the  constitution  of  the  patient, 
and  the  particular  nature  of  the  disease,  must  be  taken  fully  into 
consideration  in  deciding  on  their  respective  merits  in  each  indivi- 
dual case. 

But  the  advantages  of  Clifton,  as  a  residence  for  the  invalid,  are 
not  limited  to  the  winter ;  it  affords  also  a  very  favourable  summer 
climate.  Indeed,  the  higher  situations  on  Clifton  Hill  are  as  eligible 
during  the  latter  season,  as  the  lower  and  more  sheltered  parts  are 
during  the  former.  A  more  complete  change  of  air  than  this,  how- 
ever, will  in  general  be  advisable,  when  there  are  not  material 
objections  to  traveling.  The  interior  parts  of  the  same  district,  as 
about  Cheltenham,  and,  still  better,  the  hills  of  Malvern,  one  of  the 
coolest  and  most  healthy  summer  residences  in  England,  will  suit 
many  invalids.  For  young  persons  of  a  scrofulous  constitution, 
the  summer  climate  of  Malvern  is  admirably  suited.  Others  may 
pass  the  summer  with  more  benefit  among  the  mountains  of  Wales  ; 
and  in  cases  in  which  a  course  of  goat's  whey  promises  advantage, 
this  will  be  the  preferable  plan.  Abergavenny  is,  I  believe,  the 
most  esteemed  station  for  this  purpose.  Several  healthy  and  con- 
venient places  present  themselves  on  the  opposite  coast  of  Wales, 
as  at  Aberystwith,  Tenby,  Barmouth,  &c.,  which  form  good  resi- 


88  CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

dences  during  the  latter  part  of  summer  and  the  autumn,  more 
especially  when  sea-air  or  sea-bathing  is  indicated.  These  places, 
from  the  accommodation  of  steam  vessels,  may  be  reached  by  a 
voyage  of  a  few  hours ;  a  circumstance  of  material  consequence  to 
the  invalid  unable  to  bear  the  fatigue  of  a  journey  by  land. 

In  its  local  advantages  and  geographical  position,  therefore, 
Clifton  affords  peculiar  advantages  as  a  residence  for  a  large  class 
of  invalids.  Within  its  own  limits  it  affords  a  sheltered  winter  and 
spring,  and  an  open  airy  summer  and  autumn  residence ;  whilst  it 
is  surrounded  by  numerous  places  of  convenient  and  agreeable  resort 
in  the  fine  season,  suited  to  the  various  classes  of  persons  who  may 
seek  its  shelter  during  the  winter. 

Bristol  Hot-well. — I  must  not  quit  Bristol  without  some  notice 
of  the  once  celebrated  spring  which  formerly,  indeed,  was  the  chief 
object  of  attraction  at  this  place  for  invalids.  The  virtues  of  this 
source  were  then  as  much  overrated  as  they  appear  now  to  be 
underrated.  Yet  I  believe  many  of  the  valetudinarians,  who  fre- 
quent Clifton  on  account  of  its  climate,  might  derive  benefit  from 
the  use  of  this  water. 

According  to  Dr.  Carrick's  analysis,  made  in  1797,  it  appears  to 
be  a  very  pure  water,  having  at  its  natural  temperature  of  76°,  a 
specific  gravity  of  only  1.00077.  It  contains  a  very  small  propor- 
tion of  lime,  soda,  and  magnesia,  in  combination  with  the  carbonic, 
sulphuric,  and  muriatic  acids  ;  but  a  considerable  proportion  of  free 
carbonic  acid,  and  a  little  atmospheric  air.  The  presence  of  the 
fixed  air,  together  with  its  temperature,  renders  this  water  grateful 
to  the  stomachs  of  most  persons.  Dr.  Saunders  has  well  charac- 
terised it  as  a  pure,  warm,  slightly  acidulated  water ;  and  even  as 
such  it  will,  I  have  no  doubt,  be  found  useful  in  many  cases  of  dys- 
peysia.  Like  some  other  natural  warm  waters,  it  is  said  to  be  very 
efficacious  in  allaying  the  thirst  which  accompanies  the  paroxysms 
of  symptomatic  fever ;  and  Dr.  Riley,  of  Clifton,  informs  me  that 
he  has  found  it  of  essential  service  in  several  cases  of  diabetes. 
But  it  is  chiefly  in  a  deranged  state  of  the  digestive  organs  that  it 
is  indicated.  In  the  nervous  forms  of  dyspepsia,  when  the  stomach 
is  in  a  languid  state,  and  does  not  tolerate  cold  fluids,  it  will  prove 
useful.  During  the  spring,  several  tumblers  drunk  before  breakfast, 
with  exercise  on  foot  or  on  horseback,  according  to  circumstances, 
will,  in  many  cases,  greatly  favour  the  effects  of  the  climate,  in 
restoring  the  energy  of  the  digestive  organs,  and  thereby  improving 
the  general  health.  It  may  be  advantageously  used  also  as  a  com- 
mon drink  at  meals.  But  I  venture  these  opinions,  rather  on  the 
experience  of  others  than  my  own. 

ISLAND  OF  BUTE. 

This  island  lies  in  the  Frith  of  Clyde,  about  eighteen  miles  belovv 
Greenock,  and  is  almost  surrounded  by  the  Jofty  hills  of  the  opposite 
coast.  It  is  eighteen  miles  in  length  from  east  to  west,  arid  from  four 


CLIMATES  OF  ENGLAND.  89 

to  six  miles  in  breadth.     The  highest  parts  of  it  are  not  more  than 
140  feet  above  the  level  of  the  sea. 

The  temperature  of  Bute  never  falls  low  during  winter,  nor  rises 
high  in  summer,  so  that  its  yearly  range  is  comparatively  limited — 
under  40°,  which  is  at  least  15°  less  than  what  it  is  at  Glasgow. 
The  temperature  will  more  frequently  rise  above  75°  at  Glasgow, 
than  above  70°  at  Rothsay  in  Bute  ;  and  oftener  sink  below  20°  at 
Glasgow,  than  below  30°  at  Rothsay. 

Snow,  when  it  does  chance  to  fall,  seldom  lies  longer  than  a  few 
hours.  During  severe  and  long-continued  frost  on  the  mainland, 
and  when  the  surrounding  hills  there  are  for  many  weeks  covered 
with  snow,  a  little  may  be  seen  on  the  higher  parts  of  Bute ;  but 
even  then  the  temperature  on  the  lower  grounds  is  rarely  under 
28°  during  the  night,  and  34°  during  the  day.  In  the  whole  course 
of  twelve  years  of  the  most  careful  and  accurate  hourly  observations, 
the  thermometer  never  fell  lower  in  Bute  than  20°  above  zero  of 
Fahrenheit's  scale,  and  on  three  occasions  only  was  it  nearly  so 
low.  On  one  of  these  the  thermometer  in  the  Botanic  Gardens  at 
Glasgow,  indicated  5°  below  zero.  This  was  indeed  the  greatest 
difference  observed  during  these  twelve  years;  but  in  very  severe 
frost  the  difference  was  often  from  10  to  15  degrees.  In  ordinary 
weather  there  is  no  marked  difference  of  temperature ;  but  in  very 
hot  weather,  the  thermometer  in  Bute  does  not  rise  so  high  by 
several  degrees  as  on  the  mainland. 

Every  part  of  Bute  is  not  equally  sheltered  and  mild  during 
winter.  The  eastern  is  much  milder  than  the  northern  coast, 
owing  to  its  being  in  some  measure  protected  from  the  influence  of 
the  north  wind. 

The  climate  of  this  island  may  be  characterised  as  mild  and 
equable  but  rather  humid.  It  resembles  in  character  that  of  the 
southwest  of  England,  and  France,  and  of  the  Channel  Islands, 
though  considerably  less  warm  than  any  of  these.  As  a  winter 
residence  for  invalids,  it  holds  out  considerable  advantages  to  that 
class  only  for  whom  a  soft,  equable,  but  rather  humid  atmosphere 
is  indicated. 

The  observations  which  have  been  made  on  the  character  of 
the  diseases  benefited  by  the  climates  alluded  to,  apply  to  that  of 
Bute.1 

COVE. 
Cork  Harbour,  on  the  southern  shore  of  Ireland,  is  an  ovoid 

1  We  are  indebted  to  Mr.  Thorn  for  the  most  complete  account  of  the  cli- 
mate of  Bute  that  was  perhaps  ever  kept  of  any  place.  In  the  Appendix 
will  be  found,  a  meteorological  table,  the  results  of  twelve  years'  hourly 
observations,  which  Mr.  Thom  had  the  kindness  to  draw  up  at  my  request. 
It  is  to  be  hoped  that  he  may  publish  the  whole  of  the  data  from  which  this 
table  is  calculated,  as  they  constitute  the  most  complete  series  of  meteorolo- 
gical observations  perhaps  ever  made,  and  at  this  moment,  when  the  atten- 
tion of  men  of  science  is  particularly  directed  to  the  subject  of  meteorology, 
their  publication  is  most  desirable. 


90  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

basin,  above  seven  miles  by  five,  surrounded  by  the  mainland. 
Within,  and  on  the  northern  side  of  this  harbour,  lies  the  island  of 
Cove ;  the  extreme  length  of  which,  from  east  to  west,  is  seven, 
and  its  greatest  breadth,  three  and  a  half  miles.  The  island  con- 
sists of  two  hills,  from  two  to  three  hundred  feet  high,  running 
from  east  to  west;  the  northern  ridge  forming  the  chief  body  of  the 
island.  The  town  of  Cove,  containing  about  eight  thousand  inha- 
bitants, is  built  on  the  southern  acclivity  of  the  southern  hill.  It 
consists  of  terraces  rising  from  within  a  few  feet  of  elevation  above 
water  mark  to  a  considerable  height,  and  in  a  crescentic  form, 
facing  the  south.  From  its  posidon  and  configuration,  the  town  is 
sheltered  from  northern  winds,  on  the  one  hand,  and,  on  the  other, 
is  open  to  the  full  influence  of  the  sun. 

The  accommodations  for  invalids  are  good,  and  the  walks  and 
drives  well  sheltered.  The  facilities  of  intercourse  between  Cove 
and  other  places  are  frequent,  and  are  daily  increasing. 

The  following  observations,  by  Dr.  Scott,  relate  to  the  lower  part 
of  the  town  of  Cove. 

The  mean  annual  temperature,  deduced  from  the  mean  observa- 
tions of  the  three  years  from  September,  1834,  to  August,  1837, 
and  made  up  of  the  mean  maximum  56°. 7,  and  mean  minimum 
46°.5,  amounts  to  51°.6.  The  mean  dew-point  46°.  The  fall  of 
rain  33.299  inches,  and  the  evaporation,  calculated  from  the  mean 
temperature  and  dew-point,  about  25.643  inches. 

Fall  of  rain  in  winter  10.565  inches,  and  number  of  rainy  days 
35.  In  spring,  the  fall  is  4.06,  and  the  number  of  rainy  days  5d8. 

The  number  of  days  of  frost  and  snow,  in  winter  and  spring,  is 
very  inconsiderable.  Snow  seldom  lies  longer  than  a  few  hours. 

The  duration  of  each  wind,  during  the  three  years,  was  : — from 
the  south,  96  days;  southwest,  222;  west,  159;  northwest,  213; 
north,  132;  northeast,  84;  east,  78  ;  and  southeast,  111.1 

From  these  observations,  and  the  comparisons  given  in  the 
Tables  on  English  climates,  Cove  appears  to  be  one  of  the  mildest 
climates  in  Great  Britain  ;  being  inferior  in  point  of  temperature  to 
Penzance  only,  during  the  winter  months,  and  to  the  same  place 
and  Torquay  only  during  the  spring.  In  point  of  dryness,  Cove 
does  not  stand  so  high  in  the  table  of  comparison.  The  winter  is, 
comparatively  with  the  other  places,  the  season  during  which  the 
greatest  quantity  of  rain  falls. 

In  its  general  characters  of  climate,  and  the  influence  of  this  on 
disease,  Cove  corresponds  with  the  southwest  -of  England,  and 
other  similar  climates. 

The  subjoined  tables  exhibit  the  temperature,  the  fall  of  rain, 
and  the  number  of  rainy  days  during  the  winter  and  spring,  at  the 
principal  places  in  Britain  resorted  to  by  invalids. 

1  Dr.  Scott,  on  the  Medical  Topography  of  Cove. — Dublin  Journal  of 
Medical  Science,  vol.  xiii.  To  this  elaborate  and  excellent  paper  I  am  in- 
debted for  the  information  contained  in  the  above  article  on  Cove. 


CLIMATES  OF  ENGLAND. 


91 


COMPARATIVE  TEMPERATURE  OF  PLACES  TAKEN  BY 
REGISTER  THERMOMETERS. 


PLACES. 

Mean  Temp,  of 

Winter  |  Spring 

Mean  of 
the  two 
seasons 

Number  of  years'  Observation  from  which 
the  Means  are  taken. 

London 

39.12 

48.76 

43.94 

Nineteen  years. 

Hastings 

40.11 

45.77 

42.94 

tor   winter,  five    years,    including 
severe   winter  of    1837-38;    for 
spring,  four  years. 

Undercliff 

42.52 

48.83 

45.67 

For  winter,  six  years,  including  se- 
vere winter  of  1829-30.     Spring, 
two  years. 

Torquay 

39.83 

50.83 

45.33 

Two  years,  including  severe  winter 
of  1829-30. 

Penzance 

44.03 

49.63 

46.83 

Ten  years. 

Cove  .  .  . 

43.90 

49.43 

46.66 

Three  years. 

Bute  .  .  . 

39.62 

46.66 

43.13 

Nineteen  years. 

COMPARATIVE  QUANTITIES  OF  RAIN  CALCULATED  IN 
INCHES. 


PLACES. 

Mean  qua 
Winter. 

ntity  for 
Spring. 

No.  of  rai 
Winter. 

ny  days. 
Spring. 

Number  ot  years'  observation 
from  which   the   Means  are 
takpn  .* 

London 

5.85 

4.80 

48.0 

43.0 

Twenty  years. 

Hastings 

7.44 

3.86 

38.2 

27.2 

For  winter  and  spring,  3 
years,  including  the  rainy 
seasons,  1838-9,  1839-40. 

Undercliff 

6.17 

3.83 

43.0 

19.5 

Three  years,  including  the 
rainy  seasons,   1838-9, 
1839-40. 

Penzance 

12.64 

9.35 

50.7 

40.6 

Twelve  years. 

Cove  .  .  . 

10.565 

4.06 

35.0 

28.0 

Three  years. 

Bute  .  .  . 

10.17 

7.21 

44.7 

32.5 

Nineteen  years. 

*  The  number  of  years'  observations,  from  which  the  number  of  rainy  days 
is  deduced  for  London  and  Undercliff,  is  respectively  ten  and  two.  The 
number  of  years  for  the  other  places  is  as  in  the  Table. 


92  CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

In  bringing  to  a  conclusion  this  brief  account  of  the  warmer 
situations  in  our  own  country,  it  may  be  expected  that  I  should 
apply  the  preceding  observations  on  the  physical  characters  of  their 
climates,  to  the  object  of  our  researches,  and  say,  what  are  the  ad- 
vantages which  these  situations  hold  out  generally  to  invalids,  and 
what  are  the  diseases  in  which  they  are  respectively  beneficial. 

The  whole  of  these  places,  as  we  have  seen,  are  considerably 
warmer  during  the  winter  and  spring  than  England  generally,  and 
very  much  warmer  than  the  colder  ^parts  of  it.  Indeed,  as  I  have 
shown,  and  as  a  reference  to  the  tables  in  the  Appendix  will  fur- 
ther prove,  there  exists  as  much  difference  in  regard  to  tempera- 
ture, and  its  distribution  between  the  northern  and  southern  parts 
of  England,  as  between  the  latter  and  the  south  of  Europe.  Now 
as  the  influence  of  temperature  on  the  living  body  is,  in  a  great 
degree,  relative,  an  inhabitant  of  one  of  the  coldest  parts  of  this 
country  would,  it  is  reasonable  to  believe,  feel  the  influence  of  the 
climate  of  the  south  of  England  (as  far,  at  least,  as  regards  tem- 
perature) as  much  as  an  inhabitant  of  the  latter  would  that  of  the 
south  of  Europe.1  An  invalid,  therefore,  from  Scotland,  or  the 
north  of  England,  will  find,  in  the  places  above  mentioned,  a  cli- 
mate, compared  with  his  own,  sufficiently  mild  to  produce  a  bene- 
ficial influence  on  his  health.  Besides  this,  his  opportunities  of 
taking  exercise  in  the  open  air  will  be  much  more  frequent,  and 
being  exposed  to  a  degree  of  cold  less  severe  and  of  shorter  continu- 
ance, he  will  avoid  a  constantly  recurring  cause  of  relapse. 

But  it  must  be  kept  in  mind,  as  has  been  before  observed,  that 
there  are  other  circumstances  connected  with  the  adaptation  of 
climate  to  disease  which  require  attention,  as  well  as  temperature. 
The  particular  nature  of  the  disease  and  of  the  patient's  constitu- 
tion, and  the  character  of  the  climate  most  suitable  for  these,  will 
naturally  be  the  first  object  of  the  physician's  consideration  ;  but 
the  nature  of  the  climate  in  which  the  invalid  has  lived,  ought  also 
to  be  taken  into  account.  This  last  circumstance,  namely,  the 
comparative  influence  of  any  particular  climate  on  different  indi- 
viduals, depending  on  the  nature  of  that  which  they  previously 
inhabited,  has  not,  I  believe,  been  sufficiently  attended  to :  it  de- 

1  The  influence  of  relative  temperature  on  organic  life  might  be  aptly 
illustrated  by  a  reference  to  its  very  remarkable  effects  on  plants  ;  and  the 
influence  of  warmth,  whether  natural  or  artificial,  in  exciting  or  accelerating 
the  vegetation  of  these,  affords  matter  of  reflection  to  the  physician  in  esti- 
mating the  effects  of  climate  on  man.  It  is,  I  believe,  a  general  practice 
with  gardeners  in  respect  to  plants,  which  they  wish  to  force  rapidly  in  the 
hot  house,  to  keep  them  previously  in  as  cold  a  temperature  as  they  will 
bear.  And  it  has  been  often  proved,  that  a  vine,  accustomed  to  the  tem- 
perature of  the  open  air,  will  vegetate  in  winter,  if  transferred  to  the  hot 
house,  while  a  plant  from  the  same  stock,  accustomed  to  the  stove,  will 
remain  without  any  sign  of  budding.  See  Mr.  Knight's  Observations  on 
the  Method  of  Producing  New  and  Early  Fruit. —  Transactions  of  the  Hor- 
ticultural Society  of  London,  vol.  i. 


CLIMATES  OF  ENGLAND.  93 

serves,  however,  the  especial  consideration  of  physicians  when 
selecting  a  climate  for  their  patients. 

With  respect  to  the  merits  of  the  milder  parts  of  England  in  their 
influence  on  disease,  I  have  already  made  a  few  remarks  while 
treating  of  particular  places.  As  regards  consumptive  invalids,  for 
whom  climate  has  been  looked  to  as  the  great  resource,  I  beg  to 
refer  the  reader  to  the  article  on  consumption. 

There  is  no  one  of  the  English  climates,  as  far,  at  least,  as  our 
present  knowledge  of  them  extends,  so  much  superior  to  the  others, 
as  to  give  it  a  claim  to  a  decided  preference  in  consumptive  dis- 
eases. The  selection  must,  therefore,  depend  upon  the  nature  of 
the  individual's  constitution,  and  the  character  of  disease.  In  cases 
in  which  a  soft  and  rather  humid  air  is  known  to  agree,  the  coast 
deserves  the  preference ;  and  at  the  more  sheltered  parts  of  the 
coast  of  Devon,  as  Torquay,  and  at  Penzance,  the  generality  of 
patients  labouring  under  confirmed  pulmonary  disease,  will  find 
an  air  more  soothing  to  the  respiratory  organs  than  at  any  other 
place  frequented  by  invalids  in  our  island.  For  invalids  labouring 
under  a  relaxed  state  of  the  bronchial  membrane,  or  of  the  system 
generally,  or  where  a  strong  disposition  to  haemoptysis  has  shown 
itself,  the  drier  and  more  bracing  air  of  Clifton  will  agree  better ; 
and  Undercliff  will  prove  a  still  more  favourable  residence.  The 
climate  of  Hastings  may  be  considered  as  somewhat  intermediate 
between  that  of  Devonshire  and  Clifton ;  less  warm,  but  also  less 
relaxing  than  the  former,  it  is  about  the  same  temperature,  but  less 
dry  and  bracing  than  the  latter,  and  it  is  inferior  to  it  as  a  spring 
climate.  The  air  of  Hastings,  as  has  been  already  remarked,  is 
also  more  essentially  a  sea-air  than  that  of  any  of  these  places  ;  a 
circumstance  which  will  have  its  due  weight  with  the  physician, 
when  deciding  upon  a  climate  for  his  patient.1 

On  the  other  diseases  of  the  chest,  climate  exerts  a  very  benefi- 
cial influence.  In  the  chronic  inflammatory  affections  of  the  throat, 
trachea  and  bronchi,  of  the  dry,  irritable  kind,  or  accompanied  with 
little  secretion  or  expectoration,  the  coast  of  Devonshire  affords  a 
very  favourable  climate;  likewise  in  dysmennorhoea,  and  in  dry 
irritable  cutaneous  diseases.  In  diseases  of  the  bronchial  mem- 
brane, on  the  other  hand,  which  are  attended  with  copious  expec- 
toration, or  when  there  is  a  greatly  relaxed  state  of  the  mucous 
membrane  of  the  chest,  with  atonic  dyspepsia,  the  climate  of  the 
southwest  of  England  is  unfavourable  ;  as  it  is  in  uterine  disorders 
attended  with  copious  discharges  ;  in  menorrhagia,  and  in  all  dis- 
eases accompanied  with  a  relaxed  state  of  the  system  generally.  It 
is  difficult  to  find  any  place  in  our  island  well  suited  during  the 
whole  of  the  cold  season,  to  that  numerous  class  of  bronchial  dis- 
eases, where  there  is  a  greatly  relaxed  state  of  the  mucous  mem- 
branes, and  yet  a  constant  disposition  to  a  more  active  degree  of 
inflammatory  disease.  UnderclifF  will  be  found  one  of  the  best 

1  See  article  on  consumption. 


94  CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

climates  for  such  patients,  and  Clifton  also  is  a  good  climate. 
Brighton  is  a  very  favourable  residence  during  the  autumn  and 
part  of  the  winter,  but  after  the  month  of  February  it  is  equally 
unfavourable.  Persons  labouring  under  bronchial  disease  in  its 
less  severe  forms,  who  cannot  absent  themselves  from  London 
during  the  whole  season,  might  pass  the  autumn  at  Brighton,  re- 
main in  town  during  the  winter,  and  go  to  Undercliff  or  Clifton  for 
the  spring  months ;  or  should  this  be  inconvenient,  Chelsea, 
Brompton,  and  Kensington,  afford  sheltered  spring  situations. 

In  the  disordered  states  of  the  digestive  organs,  which  not  unfre- 
quently  lead  to  consumption,  and  in  broken  down  constitutions, 
the  genial  influence  of  a  mild  climate  is  one  of  the  most  powerful 
means  of  relief  which  we  possess.  In  those  cases  in  which,  from  a 
long  deranged  state  of  stomach,  a  sympathetic  irritation  has  been 
excited  in  the  bronchial  membrane,  and  the  person  is  liable  to 
attacks  of  catarrii  every  spring,  or  is  subject  to  habitual  cough, 
greatly  aggravated  during  that  season,  such  a  change  is  peculiarly 
beneficial.  No  class  of  invalids  is,  indeed,  more  susceptible  of  cold, 
or  suffer  more  from  it  than  dyspeptics,  more  especially  nervous 
dyspeptics.  But  a  low  degree  of  temperature  is  not  the  only  con- 
dition of  the  atmosphere  which  disagrees  with  persons  suffering 
from  stomach  complaints.  There  are  other  circumstances  in  the 
nature  of  a  climate,  cognizable  rather  by  their  effects,  than  by  the 
appreciable  physical  qualities  of  the  air,  which  exert  a  powerful 
influence  on  their  sensitive  constitutions.  Different  forms  of  this 
disease  also  derive  benefit  from  climates  of  a  different  character. 
With  persons  labouring  under  gastritic  dyspepsia,  the  climate  of 
Devonshire  will  agree,  while  it  will  decidedly  disagree  with  those 
suffering  from  the  atonic  form  of  the  disease.1  In  proportion, 
therefore,  as  the  one  or  other  of  these  conditions  predominates,  will 
this  climate  prove  beneficial  or  the  reverse;  but  I  should  scarcely 
consider  a  long  residence  in  it  advisable  in  any  form  of  dyspepsia. 
Persons  who  have  lived  in  a  drier  and  more  bracing  air  become, 
after  a  short  residence  on  this  coast,  very  sensible  of  the  enervating 
and  debilitating  influence  of  the  climate  on  their  digestive  organs. 
They  feel  a  sense  of  distention  or  oppression  in  the  region  of  the 
stomach,  with  a  torpor  of  the  whole  system,  after  meals,  indicative 
of  laborious  digestion.  In  the  nervous  forms  of  dyspepsia,  Clifton 
will  prove  a  much  more  favourable  residence  than  any  part  of  De- 
vonshire. Brighton,  during  the  autumn  and  greater  part  of  the 
winter,  agrees  admirably  with  this  class  of  dyspeptics  in  general. 

Other  situations  are,  no  doubt,  to  be  found  in  our  island,  besides 
those  which  I  have  noticed,  capable  of  affording  a  favourable  retreat 
to  the  invalid  during  our  inclement  season  ;  but  I  have  thought  it 
necessary  to  notice  those  places  only,  with  the  climates  of  which 
we  are  best  acquainted. 

It  is  probable,  that  some  may  find  my  distinciions  of  climate  too 

1  See  article  on  disorders  of  the  digestive  organs. 


CLIMATES  OF  ENGLAND.  95 

minute  and  particular,  and  my  directions  not  sufficiently  positive 
and  absolute.  To  such  I  beg  to  observe,  that  I  have  drawn  no  dis- 
tinctions for  which  1  have  not  data  ;  and  that  one  of  the  principal 
objects  of  the  second  part  of  this  work  is  to  call  the  attention  of 
the  profession  to  these  distinctions,  the  importance  of  which,  in  a 
remedial  point  of  view,  is  far  greater  than  is  generally  believed. 
Where  my  experience  has  allowed,  I  have  pointed  out  the  use  and 
application  of  these  distinctions  ;  but  when  this  has  not  been  the 
case,  I  have  preferred  to  leave  the  application  of  them  to  future  and 
more  extensive  observation ;  lest,  by  going  beyond  what  my  pre- 
mises justify,  I  might,  by  a  false  conclusion,  destroy  the  value  and 
importance  of  what  I  know  to  be  true. 

Summer  Residences. — After  this  survey  of  the  best  winter  cli- 
mates in  England,  it  may  be  expected  that  we  should  take  some 
notice  of  our  more  salubrious  summer  residences.  On  this  subject, 
however,  it  is  not  necessary  to  go  into  detail,  as  there  is  no  lack  of 
healthy  situations  to  which  our  invalids  may  repair  with  advantage 
during  this  season.  In  the  selection  of  a  summer,  as  of  a  winter 
residence,  the  same  circumstances  require  attention,  both  as  re- 
gards the  character  of  the  climate  and  the  nature  of  the  invalid's 
disease.  Even  during  this  season,  the  milder  and  more  sheltered 
situations  must  be  chosen  for  delicate  and  very  sensitive  invalids; 
while  for  the  relaxed  and  enervated,  and  those  possessing  less  sen- 
sibility, the  bracing  air  of  the  higher  and  drier  districts  will  prove 
more  suitable.  To  a  large  class  of  invalids  our  sea-side  watering 
places  offer  a  variety  of  excellent  situations  ;  and  for  those  cases  in 
which  sea-bathing  is  proper,  they  deserve  a  preference  over  the 
interior,  especially  during  the  latter  part  of  the  summer  and  au- 
tumn. Several  of  our  inland  watering  places,  independently  of 
the  advantages  to  be  obtained,  in  many  cases,  from  the  use  of  their 
mineral  waters,  afford  good  summer  climates  ;  and,  indeed,  some 
of  them,  more  on  this  account  than  any  other,  have  become  places 
of  fashionable  resort.  Among  these  we  may  mention  Malvern, 
Cheltenham,  Leamington,  Tunbridge  Wells,  Matlock,  &c.  In 
general  it  will  be  advantageous  to  invalids  who  have  resided 
during  the  summer  at  any  of  those  places,  to  pass  the  autumn  by 
the  sea-side,  as  at  some  of  the  driest  places  on  the  south,  or  south- 
east coast.  In  the  greater  number  of  cases  in  which  traveling  is 
borne  without  inconvenience,  several  changes,  or  a  succession  of 
short  journeys,  will  be  more  beneficial  to  most  invalids  than  a  resi- 
dence during  the  whole  season  in  any  one  place.  It  is  remarkable 
how  such  repeated  changes,  with  frequent  gentle  exercise,  espe- 
cially on  horseback,  renovate  the  constitution  enfeebled  by  disease, 
enable  it  to  overcome  many  chronic  affections,  and  contribute  to 
the  restoration  of  permanent  health.  But  we  shall  have  occasion 
to  recur  to  this  subject. 


96 


CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 


THE  CHANNEL  ISLANDS. 

These  islands  are  occasionally  resorted  to  by  invalids  from  this 
country,  and,  when  the  cases  are  properly  selected,  often  with  ad- 
vantage. 

Jersey  is  the  largest  of  the  Channel  Islands,  and  that  most  fre- 
quented by  invalids.  It  stretches  from  east  to  west,  and  averages 
nine  miles  in  length,  by  five  in  breadth.  From  the  north  coast, 
which  is  steep  and  craggy,  the  island  slopes  to  the  south.  It  con- 
sists almost  entirely  of  hill  and  dale,  and  abounds  in  wood  and 
verdure.  The  ground  is  thickly  hedged,  and  the  pathways  are 
bordered  by  double  files  of  trees,  planted  on  high  embankments, 
interrupting  the  view  from  the  highest  carriage.  The  general 
character  of  the  soil  of  Jersey  is  a  deep,  sandy  loam,  with  a  sub- 
soil of  red  loam  or  clay,  based  on  granite  rock,  or  schistose  forma- 
tions. Generally  speaking,  the  water  of  the  higher  situations  is 
soft  ;  of  the  lower,  hard. 

The  following  table,  from  Dr.  Hooper's  work,1  shows  the  distri- 
bution of  temperature  throughout  the  year. 

TABLE, 

Showing  the  mean  temperature  of  the  months,  seasons,  and  whole  year ; 
averaged  on  the  years  1831-32-33-34  and  35. 

March,    ......    45.75;) 

April. 50.09  C     Spring,    ....    50.97  ^ 

May, 57,08  5 


June, 61.31  > 

July, 63.50  V     Summer, 

August, 63.72  ) 


September, 


59.82  •} 


October,       55.65  C     Autumn, 

November, 48.42  J 

December, 45.27} 

January, 41.58  C     Winter, 

February, 44.623 


62.84 


54.63 


.     53.06 


43.82  J 


From  its  small  size,  and  from  its  situation  in  the  current  of  the 
channel,  Jersey  is  freely  exposed  to  all  winds.  High  winds  are 
very  prevalent.  A  perfectly  calm  day,  even  in  summer,  is  rare  ; 
and.  generally  speaking,  says  Dr.  Scholefield,  even  the  finest 
weather  may  be  called  "blowy."2  The  western  breezes,  according 
to  Dr.  Hooper,  occupy  two  thirds  of  the  year.  The  northeast  wind 
often  reigns  continuously  for  a  considerable  time,  particularly  in 


1  Observations  on  the  Topography,  Climate,  and  Prevalent  Diseases  of 
the  Island  of  Jersey.     By  George  S.  Hooper,  M.  D.,  London,  1837. 

2  Inglis's  Account  of  the  Channel  Islands.    Appendix  by  Dr.  Scholefield. 


CLIMATES  OP  ENGLAND.  97 

the  spring  months,  and  then  it  is  severely  felt  by  the  delicate  in- 
valid. 

The  actual  fall  of  rain  in  Jersey  does  not  appear  to  have  been 
measured.  Dr.  Hooper  states,  that  the  number  of  rainy  days  falls 
short  of  that  of  the  south  and  southwestern  coasts  of  England;  but 
he  is  inclined  to  think,  that  if  the  quantity  of  rain  was  estimated 
by  a  ram  gauge,  it  would  be  found  greater  at  Jersey,  as  the  showers 
there  are  generally  copious  and  of  long  duration.  In  addition  to 
the  quantity  of  rain  which  falls,  the  thickly  wooded  state  of  the 
island,  and  the  imperfect  drainage,  contribute  to  the  extreme 
humidity  of  Jersey. 

"  It  may  be  said,"  observes  Dr.  Hooper, "  that  the  island  of  Jersey 
enjoys  an  early  spring  and  a  protracted  autumn  ;  vegetation  being 
usually  active  and  forward  in  March,  and  the  landscape  of  the 
country  far  from  naked  so  late  as  the  end  of  December.  The 
dreary  aspect  of  winter,  therefore,  is  short  lived.  With  rare  ex- 
ceptions, the  latter  season  passes  off  in  soft  or  windy  weather,  with 
intervals  of  astonishingly  mild  days,  and  with  scarcely  any  frost  or 
snow.  The  prevailing  winds  of  this  season  are  the  west  and  south- 
west, and  the  actual  temperature,  its  variations  and  ranges,  are  all 
in  favour  of  the  island,  compared  with  other  places  in  neighbour- 
ing latitudes.  The  season  of  spring  is  of  course  marked  by  the 
same  unsteadiness  of  temperature  and  harsh  variations  of  weather, 
as  in  most  places  under  a  similar  latitude  ;  and  this  disadvantage 
is  particularly  felt  in  May,  which  often  fails  to  bring  with  it  the 
expected  enjoyments.  The  month  of  March,  on  the  contrary,  is 
comparatively  mild,  and  so  is  October."  Dr.  Hooper  farther  re- 
marks, (p.  71,)  that  the  general  qualities  of  the  climate  of  Jersey 
may  be  made  available  to  the  invalid,  to  whose  case  they  are  appli- 
cable, during  a  period  of  six  months  in  the  year. 

St.  Helier's,  the  capital  of  Jersey,  Dr.  Scholefield  says,  is  not 
favourably  situated  for  exercise,  and  is  peculiarly  subject  to  rain 
and  fogs.  The  most  healthy  situations  in  Jersey,  according  to  Mr. 
Murray,  are  on  the  southwest  side  of  St.  Helier's  parish.  The 
eastern  side  is  also  healthy  ;  and  St.  Aubin's,  about  three  miles  to 
the  west  of  St.  Helier's,  is  considered  one  of  the  best  situations  for 
invalids. 

The  most  prevalent  disease  in  the  Channel  Islands  is  chronic 
rheumatism,  which  among  the  people  of  the  rural  districts  is  uni- 
versal after  the  age  of  thirty  ;  dyspepsia,  diseases  of  the  liver,  and 
dropsy  are  also  prevalent.  Scrofula  is  common,  particularly  among 
the  Jewish  part  of  the  population.  Intermittent  and  remittent  fevers 
are  frequent ;  and  diseases  of  the  skin  very  much  so.  Phthisis  is 
said  not  to  be  frequent,  but  no  accurate  statistical  account  is  given. 
Calculous  diseases  are  rare  ;  inflammatory  diseases  are  not  of  acute 
character,  and  the  natives  do  not  bear  bleeding  well. 

The  climate  of  the  Channel  Islands  has  a  close  resemblance  to 
that  of  the  southwest  coast  of  England,  and  especially  to  Penzance. 
There  are  the  same  equable  temperature,  the  same  soft  humid 
1—g  7  dark 


98  CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

atmosphere,  and  the  same  liability  to  high  winds  during  the  winter, 
and  cold  northeast  winds  in  the  spring,  which  characterise  the 
latter  place.  So  close  is  the  affinity  of  their  climates,  and  so  similar 
their  influence  on  disease,  that  the  remarks  which  have  been  made 
on  the  southwest  of  Devonshire,  and  the  Land's  End,  as  residences 
for  invalids,  are  perfectly  applicable  to  the  Channel  Islands.1 


CLIMATE  OF  FRANCE, 

The  south  of  France  has  long  been  held  in  estimation  for  the 
mildness  of  its  winter  climate,  and  various  parts  of  it  have  been 
and  are  still  resorted  to  by  invalids.  The  southern  provinces,  as 
regards  climate,  admit  of  being  classed  under  two  divisions,  namely, 
the  southeastern  and  the  southwestern  ;  differing  essentially  from 
each  other  in  the  physical  characters  of  (heir  climate,  and  the  in- 
fluence of  this  on  disease. 

*  '  v  '  ^    'J         '  •  •       ' 

SOUTHWEST  OF  FRANCE. 

The  climate  of  the  southwestern  provinces  of  France  resembles 
in  its  general  qualities  that  of  the  southwest  of  England  ;  the  mean 
annual  temperature  being  about  4°  higher.  The  climate  may  be 
characterised  as  soft,  relaxing,  and  rather  humid. 

Laennec  found  the  southern  coast  of  Brittany  favourable  to  con- 
sumptive patients ;  and  he  also  observed  that  the  proportion  of 
consumptive  diseases  in  this  part  of  France,  was  comparatively 
small.  Generally  speaking,  the  climate  of  the  southwest  of  France 
will  be  found  useful  in  chronic  inflammatory  affections  of  the 
mucous  membranes  accompanied  with  little  secretion,  as  in  chronic 
bronchitis  not  attended  by  much  expectoration,  or  difficulty  of 
breathing,  and  in  similar  morbid  states  of  the  larynx  and  trachea. 
It  will  be  equally  proper  in  dry  scaly  eruptions  of  the  skin  ;  in 
dysmenorrhoea ;  in  certain  kinds  of  headach,  especially  those  in- 
duced or  exasperated  by  sharp  northeast  winds  j  and  in  high 
morbid  sensibility  in  general,  when  accompanied  with  that  habit 
of  body  which  the  ancients  called  strictum.  On  the  other  hand, 
the  same  diseases  occurring  in  relaxed  habits,  in  which  there  is  a 
disposition  to  copious  secretion,  will  be  aggravated  by  this  climate. 

PAU. 

Pau,  the  capital  of  the  Department  of  the  Lower  Pyrenees,  and 
the  only  place  in  this  district  of  which  I  consider  it  necessary  to 

1  For  fuller  and  more  particular  information  regarding  Jersey,  Dr.  Hooper's 
work,  already  referred  to,  may  be  advantageously  consulted. 


CLIMATE  OP  FRANCE.  99 

give  a  particular  account,  is  finely  situated  upon  a  ridge  of  gra- 
velly hills,  overlooking  an  extensive  valley  to  the  north.  The 
Pyrenees  rise  gradually  behind  it,  their  higher  range  being  nearly 
forty  miles  distant.  Pan  is  about  150  miles  from  Bourdeaux,  and 
50  from  Bayonne.  Having  made  but  a  short  visit  to  this  place 
myself,  T  am  principally  indebted  for  the  following  account  of  it  to 
the  kindness  of  Dr.  Playfair,  (now  of  Florence,)  who  resided  there 
for  several  years. 

Although  the  character  of  the  climate  of  Pau  corresponds  with 
that  of  the  southwest  of  Prance  generally,  it  possesses  some  pecu- 
liarities which  it  owes  to  its  topographical  situation.  Notwith- 
standing its  distance  from  the  coast,  it  is  very  much  under  the 
influence  of  the  Atlantic.  All  the  changes  to  which  this  gives  rise 
extend  as  far  as  Pau,  though  modified,  in  some  degree,  by  distance, 
and  still  more,  by  the  position  of  the  place  with  respect  to  the 
neighbouring  mountains.  Calmness,  for  example,  is  a  striking 
character  of  the  climate,  high  winds  being  of  rare  occurrence  and 
of  short  duration. 

The  mean  annual  temperature  of  Pau  is  4|°  higher  than  that  of 
London,  and  about  3°  higher  than  that  of  Penzance  ;  it  is  about  5° 
lower  than  that  of  Marseilles,  Nice,  and  Rome,  and  10°  lower  than 
that  of  Madeira.  In  winter,  it  is  2°  warmer  than  London,  3°  colder 
than  Penzance,  6°  colder  than  Nice  and  Rome,  and  18°  colder  than 
Madeira.  But  in  the  spring,  Pau  is  6°  warmer  than  London,  and 
5°  warmer  than  Penzance  ;  only  2£°  colder  than  Marseilles  and 
Rome,  and  7°  colder  than  Madeira.  The  range  of  temperature  be- 
tween the  warmest  and  coldest  months  at  Pau  is  32°  ;  this  at  Lon- 
don, and  likewise  at  Rome,  is  26° ;  at  Penzance  it  is  only  J8°,  and 
at  Madeira  14°.  The  daily  range  of  temperature  at  Pau  is  7|- ;  at 
Penzance  it  is  6£°  :  at  Nice,  Si°";  at  Rome,  11°. 

The  annual  quantity  of  rain  has  not  been  measured  at  Pau.  The 
number  of  days  in  which  rain  falls  is  109  ;  nearly  the  same  as  at 
Rome,  and  about  seventy  less  than  at  London.  The  west  wind 
blowing  directly  from  the  Atlantic,  is  accompanied  with  rain ;  the 
wind  from  the  northwest,  and  from  this  point  to  the  northeast, 
brings  dry,  cold  weather  ;  while  that  from  the  northeast  to  the 
south,  is  usually  attended  by  clear,  mild  weather.  The  south,  and 
son tli west  winds,  are  warm  and  oppressive.  The  westerly,  or 
Atlantic  winds,  are  the  most  prevalent;  the  north  wind  blows 
feebly,  and  is  not  frequent ;  the  oppressive  southerly  winds  are  of 
rare  occurrence,  and  seldom  continue  beyond  twenty-four  hours. 
Indeed,  Pau  appears  to  be  almost  exempt  from  the  oppressive 
southerly  winds  on  the  one  hand,  and  the  cold  northwest  winds  on 
the  other;  both  of  which  prevail  over  this  part  of  France  generally. 
The  easterly  winds  are  next  in  frequency  to  the  west,  with  which 
they  usually  alternate,  and  it  is  observed  that,  according  as  the  one 
or  olher  wind  prevails,  the  weather  is  rainy,  or  dry  and  pleasant. 

Though  from  the  more  frequent  occurrence  of  westerly  winds, 
this  climate  may  be  said  to  be  rainy,  still  it  is  not  subject  to  some 


100        CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

of  the  evils  which  commonly  attend  humid  climates ;  or,  at  least,  it 
suffers  from  them  in  a  less  degree  than  these  generally  do.  Rain 
seldom  continues  above  two  days  at  a  time,  and  is  usually  followed 
in  a  few  hours  by  warm  sunshine ;  while  the  ground,  from  the 
absorbing  nature  of  the  soil,  dries  rapidly.  The  atmosphere,  gene- 
rally speaking,  is  also  remarkably  free  from  moisture,  as  indicated 
by  the  hygrometer.  In  October,  some  snow  generally  falls  on  the 
centre  chain  of  the  Pyrenees  ;  and,  at  Pan,  this  fall  is  marked  by  a 
sudden  change  of  temperature,  the  weather  becoming  rainy  and 
chilly.  In  November,  the  weather  clears  up,  and  becomes  milder. 
December  and  January  are  cold  and  dry ;  frost  and  slight  snow 
showers  then  occur,  but  the  snow  does  not  lie  on  the  ground.  The 
sun  is  bright  and  warm  ;  and  from  twelve  till  three  o'clock,  an 
invalid  may  generally  take  exercise.  February  is  milder ;  but, 
towards  the  end  of  this  month  the  spring  rains  fall,  and  the  weather 
is  then  chilly  and  disagreeable.  March  is  mild,  but  variable ; 
though  there  are  no  cutting  winds.  In  spring,  westerly  winds, 
which  are  soft  and  mild,  accompanied  with  rain,  alternate  with  dry 
easterly  winds,  also  of  a  mild  character.  Hence  it  is,  that  the 
vernal  exacerbation  of  inflammatory  affections  of  the  stomach  and 
lungs,  so  commonly  observed  in  other  climates,  is  little  felt  by  in- 
valids at  Pan.  Vegetation  bursts  forth  in  the  first  week  of  April, 
which  is  a  warm  month.  May  resembles  April,  but  is  warmer.  In 
June  the  weather  is  hot  and  fine.  July.  August,  and  September, 
are  very  hot  months,  the  thermometer  sometimes  rising  as  high  as 
94°  in  the  shade  ;  with  a  very  powerful  sun,  preventing  exercise 
from  eight  in  the  morning  till  seven  in  the  evening. 

According  to  Dr.  Playfair,  the  good  qualities  of  the  winter  cli- 
mate of  Pau  may  be  summed  up  as  follows  : — Calmness,  moderate 
cold,  bright  sunshine  of  considerable  power,  a  dry  state  of  atmo- 
sphere and  of  the  soil,  and  rains  of  short  duration.  Against  these 
must  be  placed — changeableness,  the  fine  weather  being  as  short 
lived  as  the  bad ;  rapid  variations  of  temperature,  within  moderate 
limits.  In  autumn  and  spring  there  are  heavy  rains. 

Pau  is  upon  the  whole  healthy.  Intermittent  and  bilious  fevers, 
and  rheumatism,  are  the  most  prevalent  diseases.  Rheumatism, 
according  to  a  native  author,  is  the  only  disease  that  is  very  com- 
mon ;  it  exists  almost  as  an  endemic,  and  simulates  or  complicates 
almost  all  the  other  diseases.1  Goitre  is  also  very  common  among 
the  peasantry.  The  intermittent  fevers  occur  chiefly  among  the 
peasants  who  frequent  the  low  damp  grounds  in  the  neighbourhood. 

There  are  several  circumstances  in  the  climate  of  Pau  which 
render  it  a  favourable  residence  for  a  certain  class  of  invalids.  The 
atmosphere,  when  it  does  not  rain,  is  dry,  and  the  weather  fine, 
and  there  are  neither  fogs  nor  cold  piercing  winds.  The  charac- 
teristic quality  of  the  climate,  however,  is  the  comparative  mild- 
ness of  its  spring,  and  exemption  from  cold  winds.  While  the 

1  Journal  de  Physiologic,  torn.  vii.  p.  303. 


CLIMATE  OP  FRANCE.  101 

winter  is  3°  colder  than  the  warmest  parts  of  England,  and  6° 
colder  than  Rome,  the  spring  is  5£°  warmer  than  the  former,  and 
only  2|-°  colder  than  the  latter.  The  mildness  of  the  spring,  and 
its  little  liability  to  winds,  render  this  place  favourable  in  chronic 
affections  of  the  larynx,  trachea,  and  bronchi.  In  gastritic  dys- 
pepsia Dr.  Playfair  has  found  it  beneficial,  and  he  has  seen  it  useful 
in  a  few  cases  of  asthma.  With  delicate  children,  also,  he  found 
the  climate  agree  well,  especially  when  they  removed  to  the  moun- 
tains during  the  summer. 

Upon  the  whole,  Pau  appears  to  be  the  most  desirable  winter 
residence  in  the  southwest  of  France,  for  invalids  labouring  under 
chronic  affections  of  the  mucous  membranes.  In  the  same  class  of 
diseases,  the  mineral  waters  of  the  Pyrenees  are  also  very  benefi- 
cial ;  and  it  may  be  convenient,  and  advisable,  for  the  invalid,  who 
has  derived  benefit  from  a  course  of  these  waters,  to  pass  the  winter 
at  Pan,  with  a  view  of  returning  to  them  in  the  following  season. 

Invalids  labouring  under,  or  subject  to  attacks  of  rheumatism, 
should,  of  course,  avoid  Pau.  In  bronchial  diseases,  also,  when 
accompanied  with  much  general  relaxation  of  the  system,  and  with 
copious  expectoration  and  dyspnoea,  the  climate  will  not  in  general 
prove  beneficial ;  and  Dr.  Playfair  considers  it  too  changeable  in 
consumptive  diseases. 

Dr.  Foville,  who  passed  two  years  at  Pau,  for  the  benefit  of  his 
own  health,  considers  the  above  account  of  its  climate  correct  in 
the  main,  but  in  some  respects  too  favourable.  Its  greatest  advan- 
tage is  the  constant  calmness  of  the  air.  He  thinks  the  climate 
uncongenial  to  persons  with  delicate  chests.  The  inhabitants,  he 
says,  are  generally  healthy,  and  the  mortality  less  than  in  most 
cities  of  France. 

Invalids,  who  mean  to  pass  the  winter  at  Pau,  should  arrive  there 
in  the  end  of  September,  or  very  early  in  October. 

In  fixing  the  period  for  leaving  Pau,  the  destination  of  the  person 
must  be  taken  into  account.  If  the  object  is  to  return  to  England, 
he  may  leave  it  in  May;  if  he  means  to  spend  the  summer  among 
the  Pyrenees,  he  should  not  leave  it  before  June.  The  best  season 
for  using  the  mineral  waters  of  the  Pyrenees  commences  about 
the  first 'of  July. 

SOUTHEAST  OF  FRANCE. 

Various  places  in  the  southeast  of  France  have  been,  at  different 
times  recommended  as  affording  a  good  winter  climate  for  con- 
sumptive patients ;  but  nothing  can  be  more  unaccountable  than 
how  such  an  advice  ever  came  to  be  given ;  as  the  experience  of 
later  years  is  in  complete  opposition  to  it.  and  the  general  and  lead- 
ing characters  of  the  climate  show,  that  there  never  was  the  least 
reason  to  sanction  it.  How  the  practice  of  sending  consumptive 
invalids  to  the  southeast  of  France  originated,  it  is  not  of  importance 
to  inquire;  but  that  it  is  founded  on  error,  I  think  I  shall  be  able 


102         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

to  prove,  by  a  reference  to  the  total  want  of  success  which  has 
attended  it,  as  well  as  to  the  physical  characters  of  the  climate. 

The  mean  annual  temperature  of  Provence  generally,  is  58° : 
that  is,  about  7°  warmer  than  the  southwest  of  England,  3°  warmer 
than  the  southwest  of  France,  and  about  a  degree  below  Italy,  in- 
cluding the  climate  of  the  lower  Apennines.  Its  winter  temperature 
is  43°;  being  only  H°  above  the  southwest  of  England,  and  1° 
above  the  southwest  of  France,  while  it  is  3°  under  Italy.  The 
spring  temperature  is  55° ;  namely,  6°  above  the  southwest  of  Eng- 
land, 1°  above  the  southwest  of  France,  and  2°  below  Italy.  The 
temperature  is  distributed  very  unequally  through  the  year ;  the 
difference  of  the  mean  of  the  warmest  and  the  coldest  months  being 
35°;  this  in  the  southwest  of  England  is  22°,  in  the  southwest  of 
France  30°,  in  Italy  32°,  and  in  Madeira  only  14°. 

Dryness  is  one  of  the  most  remarkable  characters  of  the  climate 
of  Provence.  At  Marseilles  and  Toulon,  about  nineteen  inches  of 
rainfall  annually.  This  is  less  by  six  inches  than  what  falls  at 
London,  and  is  not  half  so  much  as  falls  in  the  southwestern  ex- 
tremity of  Cornwall.  The  annual  number  of  days  on  which  rain 
falls  in  Provence,  is  only  sixty-seven,  while  at  London  it  is  178. 
Again,  in  Provence  (at  Toulon)  the  quantity  of  water  evaporated 
annually,  is  forty  inches,  while  at  Paris  it  is  thirty-two  inches,  at 
Gosport  twenty-five,  and  at  London  only  twenty-four.  When  these 
circumstances  are  taken  into  consideration,  together  with  the  high 
mean  temperature,  the  climate  of  Provence  appears  the  driest  in 
Europe.  Indeed,  the  dry  nature  of  the  soil,  and  the  bare  parched 
aspect  of  the  country,  bespeak  this. 

Tire  general  character  of  the  climate  of  the  southeast  of  France 
is  thus  dry,  hot,  and  irritating.  Its  temperature  throughout  the 
year  and  the  day  is  distributed  with  great  irregularity,  and  the 
range  is  much  wider  than  in  our  own  climate;  being,  as  three  to 
one  for  the  year,  and  as  two  to  one  for  the  day.  The  temperature, 
no  doubt,  remains  more  steady  from  day  to  day,  than  our  own;  but 
its  changes,  though  less  frequent,  are  more  sudden  and  extensive. 
Sometimes  the  winter  is  very  rigorous.  The  orange  trees  are 
occasionally  killed  by  the  cold  in  the  most  sheltered  parts  of  Pro- 
vence. In  1709  the  ports  of  Marseilles  and  Toulon  were  frozen 
over. 

This  tract  of  country  is  subject  also  to  keen,  cold,  northerly 
winds,  especially  the  mistral,  which  prevails  during  the  winter  and 
spring,  and  is  most  injurious  in  pulmonary  diseases. 

Although  decidedly  improper  for  consumptive  patients,  and  for 
those  labouring  tinder  irritation  of  the  mucous  membranes  of  the 
stomach,  larynx,  or  trachea,  this  climate  may  prove  useful  to  invalids 
of  a  different  class.  On  persons  of  a  torpid,  or  relaxed  habit  of 
body,  and  of  a  gloomy,  desponding  cast  of  rnind,  with  whom  a 
moist  relaxing  atmosphere  disagrees,  the  keen,  bracing,  dry  air  of 
Provence,  arid  its  brilliant  skies,  will  often  produce  a  beneficial 


CLIMATE  OP  FRANCE.  103 

effect.     In  some  cases  of  chronic  intermittent  fevers,  also,  it  proves 
very  favourable. 

The  distinctive  characters  of  the  climate  prevail  more  or  less  in 
the  different  places  resorted  to  by  invalids,  but  none  can  be  con- 
sidered as  exempt  from  them.  The  remarks  which  I  have  to  make 
on  these  places  individually,  are  derived  partly  from  native  practi- 
tioners, and  partly  from  my  own  observation  ;  and  it  will  be  found, 
I  think,  that  the  particular  facts  confirm  the  general  character  given 
of  the  whole  southeast  of  France,  from  Montpelier  to  Nice. 

MONTPELIER. 

The  celebrity  of  the  medical  school  at  Montpelier,  had  probably 
a  considerable  share  in  giving  rise  to  the  character  which  this  place 
obtained  for  the  benignity  of  its  climate — olim  Cous  nunc  Monspe- 
liensis.  But  whatever  may  have  been  the  merits  of  its  medical 
school,  it  will  be  easy  to  show,  that  the  climate  little  deserved  the 
reputation  which  it  long  enjoyed  as  a  residence  for  the  consump- 
tive. I  prefer  the  evidence  afforded  on  this  subject  by  native  authors. 
M.  Murat,  in  his  Medical  Topography  of  Montpelier,  published  in 
18 10,  states  on  the  authority  of  M.  Fournie^  the  following  propor- 
tion of  deaths  from  consumption,  at  the  Hotel  Dieu,  of  that  city,  in 
the  year  1763.  The  total  number  of  patients  that  passed  through 
this  hospital  in  the  course  of  the  year  was  2,756.  The  total  num- 
ber of  deaths  was  154;  and  of  this  number  fifty-five  died  of  pulmo- 
nary consumption  ;  that  is,  more  than  a  third  of  the  whole.  After 
alluding  to  M.  Fouquier's  opinion,  that  phthisis  was  still  more 
frequent  at  a  former  period,  he  adds,  "Mais  la  phthisic  pulmonaire 
n'est  que  trop  repandue  dans  ce  pays :  elle  y  enleve  rneme  des 
families  entieres;  et  la  position  de  la  ville,  et  la  constitution  seche 
et  variable  des  saisons  physiques,  sont  des  causes  locales  qui  la 
developeront  toujours."1  M.  Fournier,  the  author  from  whom  the 
above  numbers  are  taken,  observes,  when  noticing  the  prevalence 
of  northerly  winds  at  Montpelier,  during  the  winter  and  spring,  "II 
faunt  avoir  la  poitrine  bien  bonne  et  bien  constitute  pour  resister  a 
ses  impressions."2  Other  circumstances  in  the  topography  and 
nature  of  the  climate  of  Montpelier  might  be  stated  to  show  its 
unfitness  as  a  residence  for  consumptive  patients,  but  surely  it  is 
unnecessary  to  adduce  further  evidence  on  the  subject.  Consump- 
tive patients  are  frequently  sent  from  this  place  to  the  village  of 
Gauche,  at  the  foot  of  Cevennes,  about  two  leagues  distant. 

MARSEILLES. 

This  place  is  but  little  intitled  to  claim  any  exemption  from  the 
general  character  of  the  climate  of  Provence.     It  is  open  to  the  full 

1  Topographie  Medicale  de  la  Ville  de  Montpelier,  p.  149. 
2Recueil  d'Observations  de  Medecine  des  H6pitaux  Militaires,  par  M. 
Richard  de  Hautsierck,  torn.  ii.  p.  5. 


104         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

influence  of  the  cold  winds  of  this  country,  and  especially  to  the 
mistral.  There  is,  moreover,  no  part  of  the  neighbourhood  of  Mar- 
seilles, where  invalids  can  take  exercise,  when  the  weather  does 
permit  them  to  go  out ;  one  of  the  principal  objects  for  which  they 
left  their  own  climate.  The  country  around  the  city  is  divided 
into  small  properties,  each  enclosed  by  high  walls,  between  which 
the  roads  in  every  direction  lead  for  miles.  The  dry,  arid  nature 
of  the  soil,  renders  these  roads  in  general  very  dusty,  and  the  nar- 
row winding  form,  subjects  them  to  gusts  of  wind ;  both  of  which 
circumstances  makes  them  most  improper  exercising  ground  for 
invalids  labouring  under  pulmonary  irritation.  Indeed,  it  may  be 
almost  said,  that  there  is  no  country  about  Marseilles,  at  least  for 
the  stranger  residing  there.  But  the  character  of  the  climate  is  still 
more  objectionable.  It  is  dry,  variable,  and  subject  to  cold  irritating 
winds,  which  are  particularly  injurious  to  consumptive  patients. 
Marseilles  is  indeed,  one  of  the  towns  in  France  in  which  pulmo- 
nary consumption  is  most  prevalent.  A  large  proportion  of  the 
youth  of  both  sexes  is  carried  off  by  it.  Females,  from  fourteen  to 
eighteen  years  of  age,  are  said  to  be  its  most  frequent  victims.  To 
use  the  words  of  a  native  author:  "II  fait  des  ravages  inouies  en 
moissonnant  la  plus  belle  jeunesse."1  Scrofula  attacking  the  ex- 
ternal parts  of  the  body  is  rather  a  rare  occurrence  at  Marseilles. 
Pleurisy  and  catarrh  are  frequent ;  as  are  cancer  and  cutaneous 
eruptions.  Diseases  of  the  uterine  system  are  also  common. 

Invalids  requiring  a  dry  climate,  and  capable  of  bearing  keen, 
cold  winds,  will  be  benefited  by  a  residence  at  Marseilles :  patients 
labouring  under  intermittent  fevers  often  get  rid  of  them  on  coming 
to  this  place. 

HYERES. 

The  little  town  of  Hyeres,  agreeably  situated  on  the  southern  de- 
clivity of  a  hill,  about  two  miles  from  the  shores  of  the  Mediter- 
ranean, and  twelve  from  Toulon,  is  the  least  exceptionable  residence 
in  Provence  for  the  pulmonary  invalid.  It  is  in  some  degree  pro- 
tected from  the  northerly  winds,  and  has  the  advantage  of  being 
situated  in  a  beautiful,  open  country.  Immediately  under  the  town, 
the  orange  tree  is  cultivated  in  abundance.  It  is  the  hardiest  species, 
and  thrives  very  well  in  general,  being  little  injured  by  the  winter. 
It  has,  nevertheless,  happened  several  times,  although  after  an  in- 
terval of  many  years,  that  the  cold  has  been  sufficiently  intense  to 
destroy  the  whole  of  the  orange  trees  at  Hyeres  in  one  night.  This 
occurred  last  in  the  winter  of  1820,  on  which  occasion  not  a  single 
orange  tree  escaped ;  and  many  of  the  olive  trees,  in  the  most  ex- 
posed situations,  were  also  partially  killed. 

The  lower  grounds  are  occupied  with  vines  and  corn,  and  about 

'Expose  des  Travaux  de  la  Societ<§  de  Medecine  de  Marseilles,  1816, par 
M.  Sigaud,  p.  14. 


CLIMATE  OF  FRANCE.  105 

the  bases  of  the  hills  the  olive  is  extensively  cultivated,  and  attains 
a  considerable  size.  The  hills  immediately  surrounding  Hyeres 
are  finely  covered  with  evergreen  shrubs,  affording  a  striking  con- 
trast to  the  bare,  unseemly  aspect,  which  the  hills  of  Provence 
generally  present.  The  thyme,  rosemary,  lavender,  and  many 
other  aromatic  plants  grow  here  in  abundance ;  and  several  of 
these  we  find  blooming  in  December.  With  all  these  indications 
of  mildness,  Hyeres  is  by  no  means  sufficiently  protected  from  the 
mistral  to  render  it  a  desirable  residence  for  consumptive  invalids, 
(setting  aside  objections  from  the  nature  of  the  climate,)  although  it 
has  been  strongly  recommended  as  such.  It  is  true  that  about"  the 
base  of  the  hills  there  are  some  spots  sheltered  from  the  mistral, 
where  the  invalid  might  enjoy  several  hours  in  the  open  air  almost 
every  day :  but  these  are  almost  unattainable  when  they  would  be 
most  useful.  The  chilly  blast  sweeping  round  every  exposed 
corner,  forbids  the  valetudinarian  venturing  there,  except  in  a  close 
carriage,  while  the  roads  leading  to  these  places  do  not  admit 
wheeled  vehicles.  When  the  weather  does  permit,  the  invalid 
residing  at  Hyeres  may  enjoy  the  advantage  of  a  variety  of  rides 
through  a  fine  open  country.  But  when  the  mistral  blows  with 
any  degree  of  force,  he  should  confine  himself  to  the  house,  if  his 
chest  be  delicate  ;  and  he  must  even  be  cautious  at  all  times  of  ex- 
posing himself  to  this  wind,  which,  independently  of  its  low  tem- 
perature, is  very  irritating.  With  all  these  objections,  the  climate 
of  Hyeres  is  the  mildest  in  Provence ;  and  the  invalid  may  feel 
assured,  that  whatever  inconveniences  he  is  subjected  to  from  the 
cold  winds  at  this  place,  he  would  have  experienced  in  a  greater 
degree  at  any  other  part  of  the  southeastern  district. 

NICE. 

The  climate  of  Nice  approximates  more  nearly  in  its  general 
characters  to  that  of  Provence,  which  has  just  been  described,  than 
to  any  other.  Its  mean  annual  temperature  is  59°,  being  9°  warmer 
than  London,  7°  warmer  than  Penzance,  1°  colder  than  Rome,  and 
5°  colder  than  Madeira.  The  mean  temperature  of  winter  is  48°  ; 
that  is,  nearly  9°  warmer  than  London,  4°  warmer  than  Penzance, 
1°  colder  than  Rome,  and  12°  colder  than  Madeira.  The  mean 
temperature  of  spring  is  56°;  being  7°  warmer  than  London,  6° 
warmer  than  Penzance,  1°  colder  than  Rome,  and  6°  colder  than 
Madeira.  The  temperature  throughout  the  year  is  more  equally 
distributed  at  Nice  than  at  any  place  in  the  South  of  Europe,  of 
which  we  have  accounts,  except  Rome  and  Cadiz ;  the  difference 
of  the  warmest  and  coldest  months  being  only  28°,  and  the  mean 
difference  of  successive  months  only  4°.74. 

The  range  of  temperature  for  the  day  is  also  less  at  Nice  than  at 
any  other  part  of  the  south  of  Europe ;  and  in  steadiness  of  tem- 
perature it  ranks  next  to  Madeira. 

The  mild  and  equable  character  of  the  climate  of  Nice  depends 


106         CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

in  a  great  measure  on  the  position  of  the  place  with  respect  to  the 
neighbouring  mountains  and  the  sea.  The  maritime  Alps  form  a 
lofty  barrier,  which  shelters  it  from  the  northerly  winds  during 
winter ;  and  the  cool  sea  breeze,  which  prevails  every  day,  with  a 
regularity  almost  equal  to  that  of  a  tropical  climate,  moderates  the 
summer  heat.  "  Get  alize  Mediterranean,"  says  M.  Risso,  "toujours 
donx,  frais  et  tranquilie,  s'eleve  periodiquement  vers  neuf  a  dix 
heures  dti  matin,  cesse  sou  vent  vers  les  quatre  heures  apres  midi, 
et  s'etend  dans  Pinte'rieur  de  nos  Alpes  rarement  au  dela  de  huit 
myriame'tres." l  These  circumstances  explain  the  small  annual 
range  of  temperature  at  this  place,  already  noticed,  and  which  a 
reference  to  the  table  in  the  Appendix  will  show  to  be  much  less 
than  at  most  parts  of  Italy. 

Notwithstanding  the  extent,  however,  to  which  Nice  and  its  envi- 
rons are  encircled  by  mountains,  (and  it  is  so  in  a  great  measure 
from  W.  S.  W.  to  E.  S.  E.,)  it  is  by  no  means  exempt  froni 
cold  winds  during  the  winter,  and  still  less  so  during  the  spring. 
The  easterly  winds  are  the  most  prevalent  during  the  latter 
season.  They  range  from  east  to  northeast,  frequently  blow  with 
considerable  force,  and  are  often  accompanied  with  a  hazy,  cloudy, 
state  of  atmosphere.  Sometimes  this  wind  sets  in  towards  the 
forenoon,  at  other  times  not  until  the  afternoon.  When  the  early 
part  of  the  day  is  fine,  it  never  should  be  lost  for  exercise ;  as 
the  afternoon  frequently  proves  cold  and  windy,  after  a  calm  mild 
morning. 

From  the  northwest  or  mistral,  which  is  the  scourge  of  Provence, 
Nice  is  pretty  well  sheltered.  The  force  of  this  wind  seems  to  be 
broken,  and  directed  to  the  southward  by  the  Estrelles,  a  chain  of 
mountains  between  Frejus  and  Cannes.  Although  the  mistral  is 
never  experienced  in  its  full  power  at  Nice,  or  only  at  least  towards 
its  termination,  when  it  takes  a  more  westerly  direction,  (la  queue 
de  la  Mistral,  as  it  is  called,)  the  keen,  dry  quality  of  the  air  is 
very  sensibly  felt  whilst  it  prevails.  It  sets  in  generally  about  two 
or  three  o'clock  in  the  afternoon,  and  is  not  of  Ion  *  duration.  The 
wind  seldom  blows  strong  directly  from  the  north,  though  the  air 
is  very  sharp  when  it  is  in  that  quarter.  The  northerly  gales  ap- 
pear to  pass  obliquely  over  Nice.3  The  sirocco  is  of  rare  occurrence, 

!Histoire  Naturelle  de  Principales  Productions  de  1'Europe  Meridionale, 
et  particulierement  de  celles  des  Environs  de  Nice.  1825,  par  A.  Risso.  Vol. 
i.  p.  219.  To  this  excellent  work  I  beg  leave  to  refer  ray  readers  who  may 
be  desirous  of  information  respecting  the  Natural  History  of  the  south  of 
Europe. 

l"On  eprouve  fort  rarement,"  says  M.  Risso,  "toute  sa  force  dans  les 
couches  inferieures  de  Pair  qui  environnent  le  plateau  de  Nice,  a  cause  du 
triple  rang  de  montagnes  qui  Pentourent;  il  occupe  presque  toujours  les 
couches  superieurs,  et  descend  en  pente  comme  un  grand  torrent  aerien  sur 
la  mer ;  car  on  aper9oit  a  un  kilometre  du  rivage  qu'il  commence  a  en  friser 
la  surface  pour  former  un  peu  plus  loin  des  vagues  qui,  s'elevant  les  unes 
sur  les  autres,  vont  porter  les  tempetes  sur  les  coies  boreales  d'Afrique." — 
Hist.  Nat.  vol.  i,  p.  216. 


CLIMATE  OP  FRANCE.  107 

and  when  it  does  pay  a  visit,  it  is  gentle,  and  not  unpleasant  to  the 
feelings  of  invalids  in  general. 

The  weather  at  Nice  during  the  winter  is  comparatively  settled 
and  fine,  the  atmosphere  being  generally  clear,  and  the  sky  remark- 
able for  its  brilliancy.  The  temperature  seldom  sinks  to  the  freez- 
ing point,  and  when  it  does,  it  is  only  during  the  night;  so  that 
vegetation  is  never  altogether  suspended.  Indeed,  at  Nice,  winter  is 
a  season  of  flowers,  the  dryness  of  the  air  rendering  the  same  degree 
of  cold  less  injurious  to  them,  than  it  would  be  in  a  more  humid 
atmosphere.  Spring  is  the  most  unfavourable  season  ;  the  sharp, 
chilling,  easterly  winds  are  the  greatest  enemy  with  which  the  inva- 
lid has  to  contend  ;  and  the  prevalence  of  these  during  the  months 
of  March  and  April  is  admitted,  I  believe,  by  all  who  have  felt  them, 
to  form  the  greatest  objection  to  this  climate,  especially  in  pulmo- 
nary diseases. 

The  climate  of  Nice  is  altogether  a  very  dry  one.  Rain  falls 
chiefly  during  particular  seasons.  From  the  middle  of  October  to 
the  middle  of  November  it  generally  rains  a  good  deal ;  also  about 
the  winter  solstice  there  is  commonly  some  rain,  and  again,  after 
the  vernal  equinox.  The  quantity  of  rain  that  falls  during  the  year 
has  not  been  accurately  estimated. 

Upon  the  whole,  in  the  physical  qualities  of  its  climate,  Nice 
possesses  some  advantages  over  the  neighbouring  countries  of 
Provence  and  Italy,  inasmuch  as  it  may  be  said  to  be  free  from  the 
sirocco  of  the  latter,  and  protected  from  the  mistral  of  the  former. 

Nice  is  upon  the  whole  a  healthy  place.  Catarrhal  affections 
and  inflammation  of  the  lungs  rank  among  the  most  frequent 
diseases.  The  latter  is  especially  common  and  violent  in  the 
spring,  and  is  generally  complicated  with  irritation  of  the  digestive 
organs.  Pulmonary  consumption  is  much  less  frequent  in  England 
and  France.  Gastric  fever  and  chronic  gastritis  are  very  common 
diseases.  Indeed,  gastric  irritation  appears  to  be  very  prevalent ; 
and  almost  all  other  diseases  are  complicated  with  more  or  less  of  it. 
Intermittent  fevers  are  not  unfrequent  among  the  peasantry  living 
or  labouring  in  unhealthy  situations  in  the  country.  The  flat 
ground  on  the  banks  of  the  Var  is  the  most  fruitful  source  of  these 
fevers.  The  guards  stationed  on  the  bridge  which  crosses  this 
boundary  stream,  are  frequently  attacked  with  ague,  during  the 
unhealthy  season,  though  they  remain  there  only  a  few  days  at  a 
time.  This  is  a  disease,  however,  from  which  the  winter  resident 
at  Nice  has  nothing  to  fear.  Dr.  Skirving,  during  a  long  residence 
there,  met  with  one  case  only  of  ague  amongst  the  strangers. 
Diseases  of  the  eyes  are  very  prevalent,  particularly  amaurosis  and 
cataract ;  cutaneous  diseases  are  also  very  common.  The  elephan- 
tiasis of  the  Greeks  is  occasionally  observed  in  certain  warm  spots 
in  the  neighbourhood.  It  is  also  found  sometimes  in  the  vicinity 
of  Marseilles,  and,  I  believe,  along  the  whole  of  this  coast.  It  is 
less  common  in  Italy,  except  perhaps  at  Naples. 

In  proceeding  to  describe  the  effects  of  the  climate  of  Nice  on 


108         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

disease,  I  feel  it  due  to  Dr.  Skirving,  who  practised  there  many 
years,  to  state,  that  I  am  much  indebted  to  him  for  favouring  me 
with  the  results  of  his  extensive  experience. 

In  consumption^  the  disease  with  which  the  climate  of  Nice  has 
been  chiefly  associated  in  the  minds  of  medical  men  in  this  country, 
little  benefit  I  fear  is  to  be  expected  from  it.  When  this  disease 
is  complicated  with  an  irritable  state  of  the  mucous  membranes 
of  the  larynx,  trachea,  or  bronchi,  or  of  the  stomach,  the  climate 
is  decidedly  unfavourable  ;  and,  without  extreme  care  on  the  part 
of  the  patient,  and  a  very  strict  regimen,  the  complaint  will  in 
all  probability  be  aggravated  by  a  residence  at  Nice.  Indeed,  the 
cases  of  consumption  which  ought  to  be  sent  to  this  place  are  of 
rare  occurrence.  If  there  are  any  such,  it  is  when  the  disease  exists 
in  torpid  habits,  of  little  susceptibility,  and  is  free  from  the  compli- 
cations which  have  been  just  mentioned.  Even  the  propriety  of 
selecting  Nice  as  a  residence  for  persons  merely  threatened  with 
consumption,  will  depend  much  upon  the  constitution  of  the  indi- 
vidual.  Dr.  Skirving  has  met  with  cases  which  leave  no  doubt  on 
his  mind,  that  a  residence  for  one  or  two  winters  often  proves  of 
advantage,  as  a  preventive  measure,  in  young  persons  predisposed 
to  this  disease ;  and  even  in  some  instances  when  there  was  every 
reason  to  believe  that  tubercles  already  existed  in  the  lungs,  the 
climate  has  appeared  to  be  useful.  But  in  the  advanced  stage  of 
consumption,  his  opinion,  founded  on  eight  years'  experience,  ac- 
cords with  what  has  been  already  stated  ;  and  this  is  still  further 
supported  by  the  testimony  of  Professor  Fodere,  of  Strasbourg, 
who  resided  six  years  at  Nice.1  Indeed,  sending  patients,  labour- 
ing under  confirmed  consumption,  to  Nice,  will,  in  a  great  majority 
of  cases,  prove  more  injurious  than  beneficial. 

In  chronic  bronchitis^  which  often  simulates  phthisis,  very  salu- 
tary effects  are  produced  by  a  residence  at  this  place.  Such  pa- 
tients generally  pass  the  winter  with  comparatively  little  suffering 
from  their  complaint,  and  with  benefit  to  their  general  health. 
They  are  here  able  to  be  much  in  the  open  air,  whereas,  if  they 
had  remained  in  England,  they  would  in  all  probability  have  been 
confined  during  the  greater  part  of  the  winter  to  the  house.  The 
particular  kind  of  bronchial  disease  most  benefited  by  a  residence 
at  Nice,  is  that  which  is  accompanied  with  copious  expectoration, 
whether  complicated  with  asthma,  or  otherwise]  and  in  the  chronic 
catarrh  of  aged  people  it  is  particularly  beneficial.  This  variety  of 
bronchial  disease  is  directly  the  reverse  of  that  which  is  mitigated 
by  the  southwest  of  France  and  of  England :  and  I  think  it  im- 
portant here  to  remark,  that  unless  the  distinctions  which  I  have 
pointed  out  in  bronchial  diseases,  and  their  complications,  are 
attended  to,  great  errors  must  be  committed  in  selecting  a  residence 

1  See  Voyage  aux  Aipes  Marititnes,  ou  Histoire  Naturelle,  Agraire, 
Civile  et  Medicale  du  pays  de  Nice,  &c.  Strasbourg,  1823. 


CLIMATE  OF  FRANCE.  109 

for  such  patients.  For  fuller  information  on  this  subject,  the  reader 
is  referred  to  the  article  on  "bronchial  diseases." 

The  gouty  invalid  may,  in  most  cases,  escape  his  usual  winter 
attack ;  and,  provided  he  lives  with  prudence,  his  general  health 
may  be  improved  by  a  winter's  residence  at  Nice. 

In  chronic  rheumatism,  the  climate  is  generally  very  beneficial ; 
and  its  advantages  are  also  remarkable  in  scrofulous  complaints. 
On  children  the  climate  generally  exerts  a  very  favourable  influ- 
ence, if  attention  be  paid  to  their  diet. 

In  the  numerous  train  of  hypochondriacal  and  nervous  symp- 
toms which  often  originate  in  dyspeptic  complaints,  Nice  is  bene- 
ficial ;  but  here,  again,  it  is  necessary  to  distinguish  the  particular 
character  of  the  affection.  The  cases  of  dyspepsia  most  benefited 
are  those  accompanied  with  a  torpid,  relaxed  state  of  the  system, 
with  little  epigastric  tenderness,  or  any  of  those  symptoms  which 
denote  an  inflamed  or  very  irritable  state  of  the  mucous  membrane 
of  the  stomach.  Where  the  latter  state  prevails,  Nice  will  de- 
cidedly disagree.  But  I  must  refer  to  the  article  on  "  disorders  of 
the  digestive  organs"  for  more  precise  directions  regarding  the  best 
winter  residence  for  persons  suffering  from  stomach  complaints. 

Tn  all  cases  where  there  is  great  relaxation  and  torpor  of  the 
constitution,  the  climate  of  Nice  is  extremely  useful.  In  young 
females  labouring  under  such  a  state  of  system,  connected  with 
irregularities  of  the  uterine  functions,  either  when  these  have  not 
been  established  at  the  usual  period,  or  when  they  have  afterwards 
been  suppressed,  marked  benefit  may  generally  be  expected.  In 
indicating  the  class  of  cases  alluded  to,  as  likely  to  derive  advantage 
from  the  climate  of  Nice,  I  would  designate  them  to  the  practical 
physician  as  those  that  are  usually  relieved  by  chalybeates. 

In  a  numerous  class  of  patients,  whose  constitutions  have  been 
injured  by  a  long  residence  in  tropical  countries,  by  mercury,  &c., 
and  in  which  a  dry  and  rather  exciting  climate  is  indicated,  Nice 
will  prove  favourable.  Some  cases  of  chronic  paralysis,  not  con- 
nected with  cerebral  disease,  have  also  been  found  to  derive  con- 
siderable benefit  from  a  residence  at  this  place. 

In  stating  its  general  influence  on  the  animal  economy.  I  would 
say — that  the  climate  of  Nice  is  warm,  exhilarating,  and  exciting, 
but  upon  the  whole,  irritating — more  especially  during  the  spring 
— at  least  to  highly  sensitive  constitutions.  It  is  extremely  favour- 
able to  the  productions  of  the  vegetable  kingdom,  some  of  which 
flourish  here  in  a  degree  of  luxuriance  that  is  scarcely  to  be  equaled 
in  the  other  parts  of  the  south  of  Europe.1 

1  "  Peu  de  contrees  meridionales  de  1'Europe  offrent  un  tableau  aussi  varie 
en  vegetaux  indigenes  et  exotiques  que  les  environs  de  Nice.  Dans  le  fond, 
c'est  une  masse  d'oliviers  qui  s'etend  sur  toutes  les  collines,  et  dispairait 
insensiblement  a  mesure  qu'elle  s'eloigne  du  rivage  de  la  mer.  Sur  le 
devant,  ce  sont  des  Grangers,  des  bigaradiers,  des  limoniers,  disposes  en 
jardins  qui  offrent  toute  la  luxe  des  Hesperides.  Pour  relever  la  sombre 
verdure  des  uns  et  la  monotonie  des  autres,  des  caroubiers,  des  figuiers,  des 


110         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

Invalids  who  pass  the  winter  at  Nice,  scarcely  ever  reside  in  the 
town.  Some  good  lodgings,  and  tolerably  well  situated,  overloo'k- 
ing  the  terrace,  are,  however,  now  to  be  had ;  but  in  the  suburb, 
called  the  Croix  de  Marbre,  and  along  the  sea  beach,  from  the 
town  to  the  ridge  of  mountains  where  the  plain  terminates  on  the 
west,  the  largest  and  best  houses  are  to  be  found  ;  and  here  stran- 
gers generally  reside.  At  the  foot  of  the  hill  on  which  stood 
Cimiez  there  are  also  some  good  houses  ;  and  this  is  a  situation 
preferable  to  the  lower  part  of  the  plain  for  patients  very  suscep- 
tible of  injury  from  damp. 

Invalids  should  endeavour  to  arrive  at  Nice  about  the  middle  of 
October,  or  sooner,  and  should  not  leave  it  before  the  beginning  of 
May.  Whatever  may  be  the  inconvenience  here  experienced  from 
the  spring  winds,  the  same  will  be  felt  in  a  much  greater  degree  by 
returning  through  the  South  of  France ;  and,  accordingly,  both 
Dr.  Skirving  and  myself  have  known  invalids  suffer  materially 
from  the  winds  of  Provence  by  leaving  Nice  too  early.  It  is  true 
that  the  new  road  which  has  lately  been  opened  between  Nice  and 
Genoa,  admits  of  the  invalid  moving  in  that  direction,  at  a  much 
earlier  period  than  it  would  be  advisable  for  him  to  return  over  the 
Estrelles  to  Provence ;  and  when  the  climate  of  Nice  is  found  to 
disagree,  a  change  in  the  spring  in  the  direction  of  Genoa  may,  in 
some  cases,  be  advisable. 

Villa  Franca. — This  little  town,  situated  on  the  southern  base 
or  rather  declivity  of  a  steep  and  lofty  range  of  mountains,  and 
having  a  beautiful  bay  extended  out  before  it,  is  immediately  to  the 
eastward  of  Montalbano,  which  separates  the  bay  of  Villa  Franca 
from  that  of  Nice.  From  the  north  and  northwest  winds  this  place 
is  certainly  more  effectually  protected  than  Nice ;  it  is  also  shel- 
tered from  the  northeast,  but  open  to  all  other  easterly  winds.  In 
its  general  characters  the  climate  corresponds  closely  with  that  of 
Nice ;  it  is  said  to  be  still  drier  and  somewhat  warmer,  and  it  is 
certain  that  the  vegetable  productions  are  considerably  earlier  than 
at  Nice.  At  present  there  are  very  few  accommodations  at  Villa 
Franca,  and  the  communication  with  Nice  is  extremely  inconve- 
nient. It  has  long  been  in  contemplation  to  cut  a  good  road  along 
the  sea  shore  between  these  two  places.  Should  this  be  accom- 
plished, the  accommodations  at  Villa  Franca  will,  no  doubt,  be 
speedily  increased ;  as  sites  for  building  may  be  found  in  this 
secluded  little  vale  more  effectually  protected  from  cold  winds  than 
any  part  of  the  more  open  and  extended  plain  of  Nice. 

Menton  is  also  a  very  sheltered  spot,  about  fourteen  miles  from 
Nice  on  the  Genoa  road  ;  and  San  Remo,  still  further,  is  even 
more  protected  from  easterly  winds.  The  great  mildness  of  both 

jujubiers,  des  raquettiers,  des  datliers,  des  grenadiers,  et  toutes  sortes 
d'arbres  fruitiers  distribues  sans  ordre,  en  etalant  toute  leur  vigueur,  ache- 
vent  d'orner  et  d'embellir  ce  bel  ensemble."— Hisloire  Naturelle,  &c.  vol.  i. 
p.  313,  &c. 


CLIMATES  OF  ITALY.  Ill 

places  is  indicated  by  the  flourishing  state  of  their  lemon  planta- 
tions. And  at  Bordighera,  in  the  neighbourhood  of  the  latter,  the 
palm-tree  is  cultivated  on  a  large  scale  for  the  sake  of  its  etiolated 
leaves,  of  which  it  has  long  afforded  a  supply  for  the  ceremonials 
of  the  church  of  Rome.  But  the  want  of  accommodation  at  these 
places,  at  present,  prevents  the  invalid,  to  whom  a  change  from 
Nice  might  be  advantageous,  from  availing  himself  of  it.  The  in- 
creased number  of  travellers,  however,  who  now  pass  by  the  road, 
lately  formed  from  Nice  to  Genoa,  will  most  probably  soon  afford 
the  means  of  improving  the  accommodation  along  this  beautiful 
coast. 


ITALY. 

Italy  possesses  great  diversity  of  climate,  but  my  observations  are 
limited  to  the  part  situated  between  the  base  of  the  Apennines,  and 
the  shores  of  the  Mediterranean.  The  climate  which  prevails  over 
the  whole  of  this  region,  while  it  exhibits  a  great  similarity  of  cha- 
racter, differs  in  several  respects  from  any  of  the  climates  already 
noticed.  It  is  considerably  warmer  and  less  humid,  but  subject  to 
a  greater  range  of  temperature  than  that  of  the  southwest  of  France; 
it  is  softer,  less  dry,  and  less  harsh  and  irritating  than  that  of  Pro- 
vence ;  suffering  more  from  the  heavy  oppressive  winds  of  the 
south,  and  less  from  the  dry  searching  winds  of  the  north. 

The  principal  circumstance  which  appears  to  modify  the  general 
character  of  this  climate  at  the  different  places,  is,  their  relative 
position  with  respect  to  the  sea-shore  and  the  Apennines.  In  this 
there  is  considerable  variety;  Genoa  and  Naples  are  in  the  vicinity 
of  both,  as  the  mountains  at  these  places  approach  closely  to  the 
Mediterranean  ;  Pisa  is  only  a  few  miles  distant  from  the  latter, 
and  close  to  the  Tuscan  hills,  a  branch  of  the  lower  Apennines ; 
Rome  is  about  twelve  miles  from  the  coast,  and  nearly  twice  that 
distance  from  the  mountains ;  Florence  is  quite  embosomed  in  the 
Apennines,  and  the  character  of  its  climate  is  thereby  affected  to 
such  a  degree  as  scarcely  to  admit  of  its  being  classed  with  the 
other  Italian  climates. 

GENOA. 

The  situation  of  Genoa,  hemmed  in  between  a  range  of  steep 
mountains  and  the  sea,  with  little  or  no  surrounding  country  well 
adapted  for  exercise,  renders  it  an  unsuitable  residence  for  invalids 
generally  ;  nor  is  there  much  in  the  character  of  the  climate  to 
recommend  it.  The  summer  is  hotter,  and  the  winter  colder  than 
at  Nice;  the  difference  between  the  mean  temperature  of  the 


112         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

warmest  and  coldest  months  being  35°,  while  at  Nice  it  is  only  28°. 
The  distribution  of  heat  throughout  the  year  is  also  very  unequal, 
and  the  temperature  by  no  means  steady  from  day  to  day.  The 
air  is  sharp  and  exciting,  but  with  less  of  the  irritating  quality  than 
that  of  the  southeast  of  Prance.  The  climate  is,  on  the  whole,  dry 
and  healthy,  but  not  suitable  to  delicate,  sensitive  invalids.  It  is 
more  congenial  to  relaxed,  phlegmatic  habits.  Dyspeptic  com- 
plaints and  gout  are  said  to  prevail  less  at  Genoa  than  at  most 
parts  of  Italy.  For  pulmonary  affections,  Genoa  is  decidedly  an 
improper  residence.  It  is  subject  to  frequent  and  rapid  changes  of 
temperature,  and  to  dry  cold  winds  from  the  north,  alternating 
with  warm,  humid  winds  from  the  southeast — the  two  prevailing 
winds  of  the  place.  To  these  rapid  changes  are  attributed  the  in- 
flammatory affections  of  the  respiratory  organs,  which,  with  tuber- 
cular consumption,  cause  the  greater  part  of  the  mortality  of  Genoa. 
In  some  places  in  the  neighbourhood,  more  sheltered  from  these 
winds,  inflammatory  affections  of  the  lungs  are  much  less  common 
than  in  the  city  and  its  immediate  vicinity.  Consumption  is  said 
to  be  less  rapid  in  its  course  at  Genoa  than  in  Provence.  Rheu- 
matism is  frequent,  while  gout,  as  already  mentioned,  is  compara- 
tively rare,  as  are  calculous  diseases.  Scrofula  is  common.  Inter- 
mittent fevers  are  rare,  and  of  mild  character. 

FLORENCE. 

Though  Florence  is  one  of  the  most  agreeable  residences  in 
Italy,  it  is  far  from  being  a  favourable  climate  for  an  invalid,  and 
least  of  all,  for  an  invalid  disposed  to  consumption. 

Its  situation  among  the  lower  Apennines,  by  which  it  is  almost 
encircled,  and  the  summits  of  which  are  covered  with  snow  during 
the  winter,  together  with  its  full  exposure  to  the  current  of  the 
valley  of  the  Arno,  renders  Florence  subject  to  sudden  transitions 
of  temperature,  and  to  cold  piercing  winds  during  the  winter  and 
spring.  Fogs,  too,  are  more  common  here  than  at  most  parts  of 
Southern  Italy.  The  winter  temperature  is  upon  the  whole  low, 
while  that  of  the  summer  is  high.  The  mean  annual  temperature 
is  only  H°  below  that  of  Rome ;  but  this  is  owing  to  the  great  heat 
of  summer  at  Florence ;  for  the  winter  is  only  4°  warmer  than  that 
of  London,  and  is  nearly  of  the  same  temperature  as  the  winter  at 
Penzance.  The  difference  between  the  mean  temperature  of  the 
warmest  and  coldest  months  is  36°,  which  is  one  degree  more  than 
that  of  Provence.  Nevertheless,  although  the  daily,  monthly,  and 
annual  ranges  of  temperature  are  very  great,  the  climate  is  not 
more  variable  or  unsteady  from  day  to  day  than  that  of  Rome,  and 
is  less  so  than  that  of  Naples.  The  annual  range  of  atmospheric 
pressure  is  greater  than  that  of  the  neighbouring  places.  The  an- 
nual fall  of  rain  at  Florence  is  31.6  inches,  but  the  number  of  days 
on  which  rain  falls  is  only  103,  being  fewer  than  at  Rome.  In  the 
winter  the  air  is  rather  chilly,  and  loaded  with  moisture. 


CLIMATES  OP  ITALY.  113 

*I  do  not  know  any  class  of  invalids  for  whom  Florence  offers  a 
favourable  residence.  My  own  opinion,  founded  partly  on  observa- 
tion, and  partly  on  the  reports  of  invalids,  perfectly  accords  with 
that  of  Dr.  Seymour  of  London,  and  Dr.  Down  of  Southampton, 
whose  more  extensive  opportunities  of  observation  during  a  long 
residence  and  extensive  practice  at  Florence,  make  their  testimony 
of  greater  value.  "  The  winter,"  says  Dr.  Down,  "  is  extremely 
severe  and  wet,  and  the  spring  changeable,  consequently  highly 
injurious  in  complaints  of  the  chest.  The  inhabitants  are  very  sub- 
ject to  diseases  of  the  lungs ;  and  the  acute  inflammation  of  this 
organ  carries  off  yearly  in  the  winter  and  spring  an  amazing  num- 
ber of  them,  particularly  of  the  poorer  classes,  whose  houses  are  ill 
calculated  to  afford  protection  against  the  cold  and  rains  of  these 
seasons."1  Florence  is  one  of  the  places  in  Italy  which  agrees  least 
with  children.  Intestinal  worms  are  particularly  common  there, 
and  dysentery  is  prevalent  in  autumn. 

PISA. 

Pisa  has  long  had  the  reputation  of  being  one  of  the  most  favour- 
able climates  in  Italy  for  consumptive  patients.  It  has  accordingly 
been  frequented,  and  continues  to  be  so,  by  invalids  from  this  coun- 
try. It  is  even  resorted  to,  during  the  winter,  by  invalids  from  the 
rest  of  Tuscany,  from  the  neighbouring  states  of  Lucca,  and  occa- 
sionally, also,  from  Lombardy. 

The  town  is  built  on  the  banks  of  the  Arno,  about  five  miles 
from  the  sea-shore.  The  surrounding  country  is  flat,  except  towards 
the  north,  where  a  range  of  hills  shelters  Pisa  in  some  measure  from 
the  winds  of  that  quarter.  It  is  also  protected,  in  a  considerable 
degree,  from  easterly  winds  by  the  lower  Tuscan  hills.  The  Arno, 
in  flowing  through  Pisa,  makes  a  semi-circular  sweep  to  the  north, 
so  that  the  buildings  on  the  northern  bank  of  the  river  (Lung* 
Arno)  assume  the  form  of  a  crescent  facing  the  south,  and  shelter 
the  greater  part  of  the  broad  space  between  them  and  the  river  from 
northerly  winds.  This  is  the  best  residence  for  delicate  invalids. 

Pisa  is  not  so  warm  as  Rome  in  winter,  and  is  hotter  in  summer. 
In  winter  it  is  7°  warmer  than  London,  and  2°  warmer  than  Pen- 
zance.  In  spring"  it  is  8°  warmer  than  London,  and  about  7° 
warmer  than  Penzance.  The  range  of  temperature  between  day 
and  night  is  very  considerable.  According  to  Professor  Piazzini, 
the  fall  of  rain  annually  is  very  great,  being  45.66  inches,  which  is 
nearly  as  much  as  falls  in  Cornwall.  The  climate  of  Pisa  is  genial, 
but  rather  oppressive  and  damp.  It  is  softer  than  that  of  Nice,  but 
not  so  warm ;  less  soft,  but  less  oppressive  than  that  of  Rome.  For 
invalids  who  are  almost  confined  to  the  house,  or  whose  power  of 
taking  exercise  is  much  limited,  Pisa  offers  advantages  over  either 

1  Observations  on  the  Nature  and  Treatment  of  Fevers  and  Bowel  Com- 
plaints, &c.  in  Greece.  By  J.  Soraers  Down,  M.  D. 

2— a  8  dark 


114         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

Rome  or  Nice.  The  Lung'  Arno  affords  a  warm  site  for  their  resi- 
dence, as  well  as  a  sheltered  terrace  for  their  walks ;  but  they  must 
be  careful  to  confine  themselves  to  it. 

The  most  common  acute  diseases  at  Pisa  are  peripneumony, 
dysentery,  and  gastric  fevers.  Ophthalmia  and  cataract  are  fre- 
quent; but  this  is  the  case  over  the  whole  southern  parts  of  Italy. 
Consumption  is  not  a  common  disease,  but  chronic  bronchial  affec- 
tions are  frequent ;  and  croup  is  occasionally  met  with.  At  one 
period,  intermittent  fevers  were  very  prevalent ;  but  since  the  coun- 
try around  Pisa  has  been  drained  and  cultivated,  they  are  compara- 
tively rare.  In  the  hospital,  however,  a  large  proportion  of  the 
patients  who  undergo  operations,  have  an  attack  of  this  fever, 
which  sometimes  even  assumes  the  pernicious  form.  Hospital  gan- 

frene  is  more  common  in  the  hospital  at  Pisa  than  in  most  other 
ospitals  in  Italy ;  and  the  same  may  be  said  of  diseases  of  the 
bones.  Nervous  affections  likewise  prevail,  but,  not  so  much  as  at 
Rome.  Calculous  diseases  are  so  rare,  that  Vacca,  the  celebrated 
surgeon,  during  thirty-two  years  that  he  had  been  operating  on  such 
patients  from  all  parts  of  Italy,  had  not  had  occasion  to  operate  on 
one  Pisan. 

ROME. 

The  climate  of  Rome  is  mild  and  soft,  but  rather  relaxing  and 
oppressive.  Its  mean  annual  temperature  is  10°  higher  than  that 
of  London,  8°  higher  than  Penzance,  6°  higher  than  Pau,  about  1° 
higher  than  Marseilles,  Toulon,  and  Nice ;  1°  below  that  of  Naples, 
and  4°  below  that  of  Madeira.  The  mean  temperature  of  winter 
still  remains  10°  higher  than  that  of  London,  but  it  is  only  5°  higher 
than  Penzance  ;  it  is  7°  higher  than  Pau,  1°  higher  than  Nice,  and 
somewhat  higher  than  Naples  ;  it  is  4°  colder  than  Cadiz,  and  11° 
colder  than  Madeira.  In  spring,  the  mean  temperature  of  Rome  is 
9°  above  London,  8°  above  Penzance,  not  quite  3°  above  Pau,  and 
1°  above  Nice  and  Provence ;  it  is  1°  colder  than  Naples,  and  only 
a  little  more  than  4°  colder  than  Madeira. 

In  range  of  temperature  (the  extent  of  which  is  the  leading  fault 
of  the  climate  of  the  South  of  Europe)  Rome  has  the  advantage  of 
Naples,  Pisa,  and  Provence,  but  not  of  Nice.  Its  diurnal  range  is 
nearly  double  that  of  London,  Gosport,  Penzance,  and  Madeira. 
In  steadiness  of  temperature  from  day  to  day,  in  which  our  own 
country,  with  the  exception  ot  the  southwest  of  Cornwall,  is  so 
remarkably  deficient.  Rome  comes  after  Madeira,  Nice,  Pisa,  and 
Penzance,  but  precedes  Naples  and  Pau. 

Rome,  although  a  soft,  cannot  be  considered  a  damp  climate. 
Upon  comparing  it  with  the  dry,  parching  climate  of  Provence, 
and  with  that  of  Nice,  we  find  that  about  one  third  more  rain  falls, 
and  on  a  greater  number  of  days.  It  is,  however,  considerably 
drier  than  Pisa,  and  very  much  drier  than  the  Southwest  of  France. 

At  Penzance  there  falls  about  one  third  more  rain  than  at  Rome, 


CLIMATES  OF  ITALY.  115 

and  the  number  of  rainy  days  is  also  about  one  third  greater.  This 
circumstance,  together  with  the  greater  evaporation  at  "Rome,  owing 
to  its  higher 'temperature,  must  make  a  considerable  difference  in 
the  hygrometrical  state  of  the  atmosphere,  at  the  two  places.  Rome 
is  not  so  dry  as  Madeira ;  as  there  falls  one  sixth  more  rain,  and 
the  proportion  of  wet  days  is  as  117  to  73. 

From  these  comparisons,  it  would  appear  that  the  climate  of 
Rome,  in  regard  to  its  physical  qualities,  in  one  of  the  best  in  Italy. 
One  peculiarity  of  it,  deserving  notice,  is  the  stillness  of  its  atmo- 
sphere; high  winds  being  comparatively  of  rare  occurrence.  This 
quality  of  calmness  is  valuable  in  a  winter  climate  for  pulmonary 
diseases,  and  to  invalids  generally,  as  it  admits  of  their  taking  exer- 
cise in  the  open  air  at  a  much  lower  temperature  than  they  could 
otherwise  do.  To  patients  labouring  under  bronchial  irritation, 
wind  is  peculiarly  hurtful.  When  wind  does  occur  at  Rome,  dur- 
ing the  winter  and  spring,  it  is  generally  from  the  north,  (Tramon- 
tana,} and  is  very  moderate,  at  least  when  it  continues  for  any 
considerable  time.  From  this  quarter  there  are  occasional  storms 
of  cold  winds  ;  but  these  are  of  short  duration,  being  limited,  with 
surprising  regularity  to  three  days.  The  Tramontana  is  a  dry, 
keen,  and  irritating  wind,  resembling  in  its  effects  the  cold,  sharp 
winds  of  Provence  ;  and  is  equally  to  be  guarded  against  by  inva- 
lids, who  should  not  stir  out  of  the  house  while  it  blows  with  much 
force.  The  southerly  winds  during  the  winter  and  spring  do  not 
produce  great  inconvenience  to  invalids  at  Rome.  Even  the  relax- 
ing and  enervating  effects  of  the  Sirocco  are  not  much  felt,  except 
by  the  more  sensitive,  and  plethoric  among  the  healthy,  and  by 
them  only,  after  it  has  continued  to  blow  for  a  few  days.  Debili- 
tated invalids,  on  the  other  hand,  who  suffer  from  great  irritability, 
and  a  degree  of  morbid  sensibility  of  body,  commonly  feel  the  win- 
ter sirocco  pleasant.  In  its  effects  on  the  body  this  wind  is  directly 
opposed  to  the  Tramontana.1  Notwithstanding  the  character  given 
of  this  wind  by  Celsus  it  is  the  favourite  of  the  modern  Romans ; 
and  during  the  prevalence  of  the  winter  sirocco  they  feel  the  full 
enjoyment  of  health.  In  the  months  of  March  and  April,  winds  are 
more  frequent  at  Rome ;  they  set  in  generally  in  the  forenoon,  and 
continue  till  sunset,  when  they  subside,  leaving  the  nights  calm  and 
serene.  The  effects  of  these  keen,  spring  winds,  combined  with 
that  of  a  powerful  sun,  are  severely  felt  by  the  sensitive  invalid ; 
though,  as  far  as  I  could  observe,  or  learn  from  the  testimony  of 
others,  in  a  less  degree  than  at  Naples  and  Nice,  and  perhaps  even 
than  at  Pisa. 

Diseases. — Among  the  more  prevalent  diseases  of  Rome,malaria 

1  The  effects  of  the  Tramontana  and  Sirocco  are  thus  characterised  by 
Celsus  :  "  Aquilo  tussira  movet,  fauces  exasperat,  ventrem  adstringit,  urinam 
supprimit,  horrores  excitat  item  dolorem  lateris  et  pectoris.  Sanum  tamen 
corpus  spissat  et  mobilius  atque  expeditius  reddit." — "  Austeraures  hebetat, 
sensus  tardat,  capitis  dolorem  movet,  alvum  solvit,  totum  corpus  efficit  hebes, 
humidum,  languidum." — Liber  ii.  cap.  i. 

8* 


116        CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

fevers  are  the  most  remarkable,  and  claim  our  first  notice.  In  the 
few  remarks  I  am  about  to  make  on  the  subject,  I  shall  confine 
myself  chiefly  to  those  circumstances  respecting  malaria,  which  it 
is  impoitant  for  travellers  to  know,  with  the  view  of  enabling  them 
to  avoid  its  effects. 

In  the  first  place,  I  may  observe,  that  the  malaria  fevers  of  Rome 
are  exactly  of  the  same  nature,  both  in  their  origin  and  general 
characters,  as  the  fevers  which  are  so  common  in  the  fens  of  Lin- 
colnshire and  Essex,  in  our  own  country,  in  Holland,  and  in  certain 
districts,  over  the  greater  part  of  the  globe.  The  form  and  aspect 
under  which  these  fevers  appear,  may  differ  according  to  the  con- 
centration of  the  cause,  or  to  some  peculiar  circumstances  in  the 
nature  of  the  climate,  or  season  in  which  they  occur ;  but  it  is  the 
same  disease,  from  the  fens  of  Lincolnshire  and  the  swamps  of 
Walcheren,  to  the  pestilential  shores  of  Africa;  only  increased  in 
severity,  cateris  paribus,  as  the  temperature  of  the  climate  increases. 
In  England,  and  in  Holland,  these  fevers  generally  appear  in  the 
simple  intermittent  form;  more  rarely  in  the  remittent  form;  and 
they  are,  for  the  most  part,  easy  of  cure.  In  France,  especially  to- 
wards the  south,  the  same  fevers  often  assume  a  more  formidable 
character.  Those  which,  from  their  unusual  severity,  and  the 
peculiar  character  of  their  symptoms,  have  received  the  name  of 
pernicious,  are  by  no  means  uncommon  in  the  southwest  of  France; 
and  in  the  rice  districts  of  Lombardy,  they  are  met  with  in  all  their 
varieties  ;  and  with  a  degree  of  severity,  perhaps  equal  to  the  more 
aggravated  forms  of  the  malaria  fevers  of  Rome.  Even  in  this 
country  intermittent  fevers  occasionally  assume  the  pernicious 
form,  and  unless  medical  practitioners  in  our  malaria  districts  keep 
this  in  mind,  patients  may  be  lost  before  the  real  nature  of  the 
disease  is  discovered. 

Malaria  fevers  seldom  appear  at  Rome  before  July,  and  they 
cease  about  October;  a  period  during  which  few  strangers  reside 
there.  The  fevers  of  this  kind  which  occur  at  other  seasons  are 
generally  relapses,  or  complicated  with  other  diseases.  One  of  the 
most  frequent  exciting  causes  of  this  fever,  is  exposure  to  currents 
of  cold  air,  or  chills  in  damp  places,  immediately  after  the  body  has 
been  heated  by  exercise,  and  is  still  perspiring.  This  is  a  more 
frequent  source  of  other  diseases  also,  among  strangers  in  Italy, 
than  is  generally  believed  by  those  who  are  unacquainted  with  the 
nature  of  the  climate.  Exposure  to  the  direct  influence  of  the  sun, 
especially  in  the  spring,  may  also  be  an  exciting  cause :  it  has  cer- 
tainly appeared  to  me  to  produce  relapses.  Another  cause  of  this 
disease  is  improper  diet.  An  idea  prevails,  that  full  living  and  a 
liberal  allowance  of  wine,  are  necessary  to  preserve  health  in  situa- 
tions subject  to  malaria.  This  is  an  erroneous  opinion;  and  I  have 
known  many  persons  suffer  in  Italy  from  acting  on  it.  A  deranged 
state  of  the  digestive  organs  is  generally  the  consequence  of  this 
regimen;  and  under  such  circumstances  the  individual  is  much 
more  liable  to  disease  of  every  kind.  Irregularities  in  diet  are  one 


CLIMATES  OP  ITALY.  117 

of  the  most  frequent  exciting  causes  of  malaria  fever  among  the 
peasantry  about  Rome,  who  are  the  principal  sufferers  from  it.  A 
plain  and  moderate  diet,  as  it  is  the  most  conducive  to  health  gene- 
rally, so  it  must,  in  the  present  case,  best  aid  the  constitution  in 
resisting  the  cause  of  this  fever.  If  there  is  any  one  circumstance 
in  the  state  of  the  constitution,  which  more  than  another  enables  it 
to  combat  and  to  pass  through  disease,  it  is,  according  to  my  ob- 
servation, a  healthy  condition  of  the  digestive  organs.  In  every 
situation  of  life,  at  all  ages,  and  in  every  climate,  this  holds  true. 

In  regulating  the  diet  of  persons  living:  in  a  malaria  country, 
regard  should  be  had  to  the  nature  of  the  climate.  The  same 
stimulating  regimen  which  might  be  borne;  and  even  prove  useful, 
in  the  damp,  chilly  atmosphere  of  Holland,  will  not  be  suited  to  the 
exciting  climate  of  Italy.  The  peasantry  in  some  parts  of  Italy  are 
very  sensible  of  this.  Sleeping  with  open  windows,  either  during 
the  day  or  night,  more  especially  in  places  subject  to  these  fevers, 
is  very  dangerous ;  and  I  have  known  repeated  instances  of  fever 
produced  in  this  way.  Towns  are  always  safer  than  villages,  and 
the  latter  than  country  houses ;  and  the  central  parts  of  a  town 
again  are  safer  than  the  suburbs. 

Much  has  been  said  about  the  healthy  and  unhealthy  quarters  of 
Rome ;  and  in  this  respect  there  certainly  is  a  material  difference  in 
the  summer  ;  but  in  the  season  during  which  strangers  reside  there, 
this  circumstance  demands  much  less  consideration.  More  is  to  be 
feared  from  currents  of  cold  air  in  the  winter,  than  from  a  confined 
humid  atmosphere,  which  last  is  the  evil  to  be  avoided  during  sum- 
mer. This  circumstance,  respecting  the  effects  of  different  seasons, 
requires  attention,  inasmuch  as  a  residence  that  may  be  very  proper 
during  the  winter,  may  not  be  so  in  summer. 

It  may  be  stated,  as  a  general  rule,  that  houses  in  confined,  shaded 
situations,  with  damp  courts  or  gardens,  or  standing  water  close  to 
them,  are  unhealthy  in  every  climate  and  season :  but  especially  in 
a  country  subject  to  intermittent  fevers,  and  during  summer  and 
autumn.  The  exemption  of  the  central  parts  of  a  large  town  from 
these  fevers  is  explained  by  the  dryness  of  the  atmosphere  and  by 
the  comparative  equality  of  temperature  which  prevails  there. 
Humid,  confined  situations,  subject  to  great  alternation  of  tempera- 
ture between  day  and  night,  are  the  most  dangerous.  Dryness,  a 
free  circulation  of  air,  and  a  full  exposure  to  the  sun,  are  the  mate- 
rial circumstances  to  be  attended  to  in  choosing  a  residence.  Of  all 
the  physical  qualities  of  the  air,  humidity  is  the  most  injurious  to 
human  life;  and,  therefore,  in  selecting  situations  for  building, 
particular  regard  should  be  had  to  the  circumstances  which  are 
calculated  to  obviate  humidity  either  in  the  soil  or  atmosphere.  A 
person  may,  I  believe,  sleep  with  perfect  safety  in  the  centre  of  the 
Pontine  Marshes,  by  having  his  room  kept  well  heated  by  a  fire 
during  the  ni^ht. 

Persons  attacked  by  this  fever  should  be  strictly  confined  to  the 
house  until  the  disease  has  been  completely  checked  ;  after  which, 


118         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

the  sooner  they  change  the  air,  the  more  likely  will  they  be  to  avoid 
relapses,  and  to  prevent  a  disposition  to  a  return  of  the  disease  from 
being  fixed  on  the  constitution — a  circumstance  of  great  conse- 
quence to  the  future  health  of  the  individual.  During  the  autumn 
or  winter,  such  persons  may  go  to  Naples ;  but  if  the  spring  is  far 
advanced,  Florence  will  be  the  better  place. 

The  next  circumstance  connected  with  the  diseases  of  Rome, 
which  deserves  notice,  is  the  peculiar  sensibility  of  the  nervous 
system  of  its  inhabitants.  This  is  evinced,  in  a  very  particular 
manner,  by  the  disposition  to  convulsive  affections,  and  the  singu- 
lar sensitiveness  of  the  Romans,  especially  the  females,  to  perfumes. 
This  peculiar  susceptibility  of  the  nervous  system,  appears  to  be  of 
recent  origin.  We  learn  from  ancient  authors  that  the  Roman 
matrons  were  fond  of  perfumes ;  and  as  the  circumstance  is  not 
mentioned  by  the  Roman  medical  authors  who  have  more  recently 
written  on  the  climate  and  diseases  of  Rome,  for  instance,  Petronio, 
Baglivi,  Marsilio  Cagnato,  and  Lancisi,  there  can  be  little  doubt 
that  it  did  not  exist  in  their  time.  It  is  to  be  remarked,  that  it  is 
not  disagreeable  odours  which  produce  such  effects  on  the  nervous 
system,  but  the  more  delicate,  and,  to  northern  nations,  agreeable 
odours  of  flowers,  and  other  perfumes.  Headaches,  and  numerous 
other  nervous  affections,  are  produced  by  such  odours. 

The  Roman  physicians,  who  agree  in  the  recent  growth  of  this 
morbidly  sensitive  state  of  the  nervous  system  among  the  inhabi- 
tants of  Rome,  cannot  fix  upon  any  other  circumstance,  to  which  it 
can  be  fairly  attributed,  except  the  indolent  manner  of  life  of  the 
Romans,  which  favours,  especially  in  such  a  climate,  the  relaxation 
and  sensibility  of  the  system.  Thus  Dr.  De  Matthaeis,  after  remark- 
ing that  powerful  odours  have  at  all  times  produced  sensible  effects 
on  the  system,  observes,  that  "there  is  nothing  wonderful  in  this,  if 
we  consider  the  daily  increasing  mobility  of  the  nervous  system, 
produced  by  the  luxurious  and  inactive  life  of  our  Romans."1  Such 
most  likely  was  the  source  of  this  idiosyncrasy,  and  no  doubt  still 
tends  to  maintain  it;  while  the  morbid  sensibility  of  the  nervous 
system,  once  acquired,  is,  doubtless,  transmitted  from  parent  to 
child.  But  though  much  may  depend  on  the  effeminate  and  indo- 
lent manner  of  living  at  Rome,  the  climate,  I  believe,  has  some 
specific  effect  in  inducing  this  state  of  the  nervous  system.  The 
habits  of  the  Romans  differ  little  from  those  of  the  inhabitants  of 
the  other  large  towns  in  Italy,  for  instance,  Naples,  Florence, 
Genoa,  &c. :  and  yet  this  morbidly  sensitive  state  of  the  nervous 
system  does  not  exist,  by  any  means,  in  the  same  degree,  in  these 
places.  Even  a  temporary  residence  of  some  duration  in  Rome, 
produces  a  degree  of  the  same  morbid  sensibility,  and  that  in  cases 
where  the  Roman  mode  of  living  cannot  be  adduced  as  the  cause. 

Another  disease,  or  rather  class  of  diseases,  of  much  more  serious 
character,  but  also,  in  a  great  degree,  of  modern  origin,  is  particu- 

1  De  Matthaeis  Ratio  Instituti  Clinici  Rotnani, 


CLIMATES  OF  ITALY.  119 

larly  frequent  among  the  Romans,  under  the  name  of  Accidente, 
and  speedily  proves  fatal.  Apoplexy  and  other  diseases  of  the  brain, 
and  diseases  of  the  heart  and  large  blood-vessels,  are,  I  believe,  the 
most  frequent  causes  of  these  sudden  deaths,  and  originate  partly  in 
the  same  sources  as  the  nervous  affections  we  have  already  noticed  ; 
as  do  likewise  the  capiplenium,  languor,  and  ezpletio,  which  Pe- 
tronius  remarks  as  morbid  dispositions  particularly  common  among 
the  Romans  of  his  time. 

Inflammatory  affections  of  the  chest  rank  next,  in  point  of  fre- 
quency, among  the  diseases  of  winter  and  spring  at  Rome.  Acute 
inflammation  of  the  lungs  appeared  to  me  more  violent  and  more 
rapid  in  its  course,  than  in  England  and  other  northern  countries. 
This  remark  does  not  apply  to  Rome  only,  but  I  believe  to  the 
whole  of  Italy,  and  to  warm  climates  generally.  When  at  Dresden, 
the  late  celebrated  German  physician,  Dr.  Kreysig,  remarked  to  me 
that  he  had  never  witnessed  such  violent  cases  of  pneumonic  inflam- 
mation in  Germany,  as  he  saw  during  his  stay  at  Pavia.  In  Rome, 
the  obstinacy  and  mortality  of  pulmonary  diseases  are  greatly  in- 
creased, by  their  frequent  complication  with  enlarged  and  otherwise 
diseased  abdominal  viscera,  the  consequence  of  malaria  fever. 

Pure  tubercular  consumption  is  not  of  very  frequent  occurrence 
at  Rome,  the  greater  number  of  chronic  affections  of  the  lungs 
being  the  effect  of  inflammation.  These  occur  chiefly  among  the 
lower  classes,  who  are  badly  clothed  during  the  winter,  and  many 
of  whom  are  predisposed  to  such  affections  from  having  already 
suffered  from  repeated  attacks  of  intermittent  fever,  which  have  left 
behind  them  obstructions  of  the  abdominal  viscera. 

Headaches  are  common  at  Rome,  and  among  strangers  I  found 
them  of  very  frequent  occurrence.  On  the  other  hand,  I  met  with 
several  instances  of  habitual  headaches  in  young  persons  disappear- 
ing during  a  residence  there.  In  some  cases  the  headaches  were  of 
the  pure  nervous  character,  but  a  large  proportion  of  them  originated 
in  errors  of  diet,  and  were  generally  remedied  by  avoiding  these. 
Persons  subject  to  this  complaint,  especially  if  it  is  connected  with 
irritation  of  the  stomach,  should  be  particularly  careful  of  their  diet 
at  Rome,  where,  owing  to  the  greater  sensibility  of  the  nervous 
system,  slighter  causes  produce  headache  than  in  this  country. 

Among  the  diseases  benefited  by  a  residence  at  Rome.  I  may  rank 
consumption.  In  the  early  stages  of  this  affection,  I  have  generally 
found  the  climate  favourable.  I  have  frequently  known  patients 
who  had  left  England  labouring  under  symptoms  that  gave  much 
and  just  alarm,  and  which  continued  during  the  whole  journey,  get 
entirely  rid  of  them  after  a  short  residence  in  Rome.  The  same 
persons  have  remained  comparatively  free  from  all  bad  symptoms 
during  the  whole  season  ;  and  this,  when  from  the  ultimate  result 
of  the  case,  there  could  be  no  doubt  of  the  existence  of  tuberculous 
disease  at  the  time.1  In  the  advanced  stages  of  consumption,  the 

8  Dr.  Carlyle,  who  resided  six  winters  at  Rome,  writes  me,  that  he  was 


120         CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE, 

climate  produced  no  benefit,  the  disease  generally  proceeding  in  the 
usual  course,  often  more  rapidly  (especially  during  the  spring 
months)  than  it  would  have  done  in  England. 

In  bronchial  affections  the  climate  is  very  generally  beneficial, 
especially  in  cases  where  there  prevails  great  irritability  of  the 
bronchial  membrane,  with  much  sensibility  to  harsh,  cold  winds.  I 
have  known  many  such  patients  express  themselves  as  feeling  much 
better  at  Rome  than  at  Nice,  or  any  of  the  other  places  where  they 
had  resided.  Nothing  was  more  common  than  to  meet  with  bron- 
chial diseases,  which,  after  having  been  benefited  by  a  short  resi- 
dence at  Rome,  were  greatly  aggravated  by  a  visit  to  Naples,  and 
again  relieved  by  the  return  to  Rome.  In  chronic  bronchitis, 
indeed,  more  especially  when  the  disease  was  of  the  dry  irritable 
kind,  or  was  complicated  with  irritation  of  the  digestive  organs,  a 
residence  at  Rome  produced  the  best  effects ;  and  in  cases  of  this 
kind  I  consider  it  the  most  favourable  residence  on  the  Continent. 

Chronic  Rheumatism  is  generally  much  relieved ;  but  as  this 
disease  is  very  frequently  consequent  to,  or  connected  with,  a  dis- 
ordered state  of  the  digestive  organs,  it  is  necessary  to  take  into 
account  the  particular  form  of  dyspepsia,  before  sending  a  rheumatic 
patient  to  Rome.  See  the  article  on  "Rheumatism." 

With  persons  disposed  to  apoplexy,  or  who  have  already  suffered 
from  paralytic  affections,  and  valetudinarians  of  a  nervous,  melan- 
cholic temperament,  or  subject  to  mental  despondency,  the  climate 
of  Rome  does  not  agree ;  and  in  many  such  cases,  indeed,  a  resi- 
dence at  Rome  is  fraught  with  danger ;  nor  is  it  proper  for  persons 
disposed  to  hemorrhagic  diseases,  or  for  those  who  have  suffered 
from  intermittent  fevers. 

No  city  in  the  south  of  Europe  frequented  by  invalids,  affords 
greater  facilities  for  exercise  in  the  country  than  Rome.  In  the 
variety  and  extent  of  its  rides  it  exceeds  every  other  large  city  I 
have  visited  on  the  Continent.  This  circumstance,  and  the  imme- 
diate vicinity  of  the  public  walks  to  that  part  chiefly  occupied  by 
strangers,  renders  Rome  a  far  less  objectionable  abode  for  invalids 
than  the  generality  of  large  towns.  The  Piazza  di  Spagna,  and 
streets  in  that  vicinity,  afford  the  best  residences.  The  streets  that 
run  in  an  easterly  and  westerly  direction  are  to  be  preferred  to  those 
running  north  and  south,  as  they  are  less  exposed  to  currents  of  cold 
air  during  the  prevalence  of  northerly  winds,  and  the  houses  have 
a  better  exposure.  Both  the  sitting  and  bedrooms  of  delicate  inva- 
lids should,  if  possible,  have  a  southern  aspect.  I  had  the  tempera- 
ture of  several  bedrooms  noted  in  the  night,  and  early  in  the 
morning,  and  found  considerable  difference  between  those  exposed 
to- the  north  and  south.  Nervous  persons  should  live  in  the  more 
open  and  elevated  situations. 

struck  with  the  remarkable  influence  of  the  climate  in  preventing  the  develop- 
ment, and  checking  the  progress  of  tubercular  disease  in  young  persons  of  a 
strumous  constitution. 


CLIMATES  OF  ITALY,  121 

Besides  care  in  the  selection  of  apartments,  there  are  other  cir- 
cumstances which  require  peculiar  attention  from  the  invalid  re- 
siding at  Rome.  There  is  no  place  where  so  many  temptations 
exist  to  allure  him  from  the  kind  of  life  which  he  ought  to  lead. 
The  cold  churches,  and  still  colder  museums  of  the  Vatican  and 
the  Capitol,  the  ancient  baths,  &c.  are  full  of  danger  to  the  delicate 
invalid  ;  and  if  his  visits  to  these  be  long,  or  frequently  repeated,  he 
had  better  have  remained  in  his  own  country.  When  an  invalid 
does  venture  into  them,  his  visit  should  be  short,  and  he  should 
choose  for  it  a  mild  warm  day.  It  is  a  grievous  mistake  to  imagine 
that  when  once  in  such  a  place  the  evil  is  done,  and  that  one  may 
as  well  remain  to  see  the  thing  fully.  This  is  far  from  being  the 
case.  A  short  visit  to  these  places  is  much  less  dangerous  than  a 
long  one.  The  body  is  capable  of  maintaining  its  temperature,  and 
of  resisting  the  injurious  effects  of  a  cold  damp  atmosphere  for  a 
certain  length  of  time  with  comparative  impunity.  But  if  the  inva- 
lid remain  till  he  becomes  chilled,  and  till  the  blood  forsakes  the 
surface  and  extremities,  and  is  forced  upon  the  internal  organs,  he 
need  not  be  surprised  if  an  increase  of  his  disease,  whether  of  the 
lungs  or  of  the  digestive  organs,  be  the  consequence  of  such  expo- 
sure. Once,  and  again,  these  visits  may  be  made  without  any 
evident  mischief;  but  sooner  or  later  their  evil  effects  will  be  mani- 
fest, as  I  have  very  often  witnessed.  The  invalid,  unwilling  to 
admit  the  real  cause  in  such  cases,  is  too  apt  to  impute  to  the 
climate,  that  which  in  truth  arises  from  his  own  imprudence  and 
indiscretion,  in  exposing  himself  to  causes  which  are  not  necessarily 
connected  with  the  climate.  Excursions  into  the  country,  when  the 
warm  weather  of  spring  commences,  particularly  when  made  on 
horseback,  is  another  and  a  frequent  source  of  mischief  to  delicate 
invalids. 

The  invalid  should  arrive  at  Rome  in  October,  and  if  the  chest 
be  the  part  affected,  and  he  is  still  very  sensible  to  the  spring  winds, 
the  beginning  of  May  will  be  sufficiently  early  for  him  to  leave  it. 
After  this  time  he  should  move  northwards,  being  guided  by  the 
weather  as  to  the  period  of  crossing  the  Alps  ;  though  this  should 
scarcely  be  done  before  the  middle,  or  end  of  June.  About  the 
Lago  Maggiore,  or  Lago  di  Como.  the  invalid  may  pass  a  week  or 
two,  if  the  weather  is  such  as  to  render  it  prudent  for  him  to  delay 
crossing  the  mountains.  The  Simplon  at  this  season  is  the  best 
route  from  Italy  to  Switzerland. 

NAPLES. 

In  its  general  characters  the  climate  of  Naples  resembles  that  of 
Nice  more  than  any  other.  As  at  Nice,  the  autumn  and  winter  are 
generally  mild,  and  the  spring  is  subject  to  cold,  sharp,  irritating 
winds,  rendered  more  trying  and  hurtful  to  invalids  by  the  heat  of 
a  powerful  sun.  The  climate  of  Naples  is  much  more  changeable 
than  that  of  Nice;  arid,  if  somewhat  softer  in  the  winter,  it  is  more 


122         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

humid.  The  sirocco,  which  is  little  known  at  Nice,  is  severely  felt 
at  Naples.  The  mean  annual  temperature  is  higher  than  that  of 
Rome,  Pisa,  or  Nice;  but  the  annual  range  of  mean  temperature  is 
very  considerable,  being  30°,  whilst  that  of  Nice  is  but  28°  ;  and  that 
of  Rome  only  26°.  The  distribution  of  temperature  in  the  different 
months  is  more  unequal  than  at  Nice  or  Rome.  The  daily  range 
of  temperature  is  also  very  great,  being  2°  more  than  at  Rome. 
The  temperature  likewise  varies  very  much  from  day  to  day,  as 
will  appear  from  the  following  statement : — The  mean  variation  of 
successive  days  at  Naples  is  3°  36 ;  at  Rome  it  is  2°  80 ;  at  Nice 
2°  33.  The  annual  range  of  atmospheric  pressure  is  very  small — 
somewhat  less  than  at  Rome,  and  very  considerably  less  than  in  the 
Southeast  of  France.  Rain  falls  less  frequently  at  Naples  than  at 
Rome. 

Of  the  diseases  of  the  inhabitants  of  Naples,  catarrhal  affections 
are  the  most  common.  Consumption  is  not  very  frequent,  nor  in 
general  rapid  in  its  course :  autumn  is  said  to  be  the  most  fatal  sea- 
son to  the  consumptive.  Rheumatism  is  very  frequent.  Nervous 
affections  are  also  common,  as  are  cutaneous  eruptions,  and  diseases 
of  the  uterine  system.  Naples  is  not  subject  to  any  endemic  disease, 
although  intermittent  fever  is  not  unfrequent  in  some  places  in  the 
outskirts  of  the  city.  Inflammation  of  the  eyes  is  very  prevalent. 

Of  Naples  as  a  residence  for  invalids  it  is  unnecessary  to  say 
much.  Consumptive  patients  should  certainly  not  be  sent  there. 
The  qualities  which  have  been  pointed  out  in  its  climate,  sufficiently 
mark  it  as  a  very  unsuitable  residence  for  this  class  of  invalids ;  and 
to  the  list  of  its  defects  must  be  added  that  of  its  topographical  posi- 
tion, which  affords  no  proper  places  for  exercise,  without  such  ex- 
posure as  would  prove  highly  injurious  to  delicate  invalids.  For 
chronic  rheumatism  the  climate  is  certainly  inferior  to  that  of  Nice 
and  Rome.  Naples  is,  however,  well  suited  as  a  winter  residence 
for  those  who  are  labouring  under  general  debility  and  deranged 
health,  without  any  marked  local  disease.  The  beauty  of  its  situa- 
tion, the  brilliancy  of  its  skies,  and  the  interest  excited  by  the  sur- 
rounding scenery,  render  it  a  very  desirable  and  very  delightful 
winter  residence,  for  those  who  require  mental  amusement  and 
recreation  for  the  restoration  of  their  general  health,  rather  than  a 
mild,  equable  climate  for  the  removal  of  any  particular  disease. 

With  respect  to  choice  of  situation  in  Naples,  invalids  with  whom 
a  warm  and  rather  close  atmosphere  agrees,  will  find  themselves 
best  in  the  Borgo  di  Chiaja,  Vittoria,  or  Chiatamone.  For  patients 
labouring  under  nervous  dyspepsia,  and  for  nervous  invalids  gene- 
rally, the  Largo  del  Castello,  Pizzo  Falcone,  and  Santa  Lucia, 
afford  more  favourable  residences. 

The  Neapolitan  physicians  generally  condemn  the  vicinity  of  the 
sea  in  consumptive  cases,  and  think  such  patients  do  better  in  the 
more  sheltered  places  behind  the  town,  and  in  the  neighbourhood 
of  the  Studio;  but  here  strangers  do  not  reside.  Of  the  situations 
frequented  by  strangers,  the  Borgo  di  Chiaja  and  Chiatamone  afford 


CLIMATES  OF  ITALY. 


123 


altogether  the  best  residences  for  pulmonary  invalids.  These  situa- 
tions are  fully  exposed  to  the  south,  and  pretty  well  sheltered  from 
the  north;  while  their  immediate  vicinity  to  the  public  gardens 
(Villa  Reale)  is  convenient  for  walking  exercise.  But,  as  I  have 
already  observed,  Naples  is  altogether  an  unsuitable  residence  for 
pulmonary  invalids. 

MALTA. 

Malta  is  in  the  36th  degree  of  north  latitude,  and  at  a  greater 
distance  from  the  mainland  than  any  other  island  in  the  Mediter- 
ranean. Its  circumference  is  from  sixty  to  seventy  miles,  its  greatest 
length  eighteen  miles,  and  its  greatest  breadth  twelve.  Most  of  the 
southern  coast  is  formed  of  high  perpendicular  rocks  ;  the  other 
parts  are  low  and  have  a  very  barren  appearance.  The  highest 
ground  is,  according  to  Dr.  Sankey.  something  more  than  600  feet 
above  the  level  of  the  sea.1 

The  whole  island  consists  of  calcareous  rock  covered  with  but  a 
scanty  mould.  Notwithstanding  this,  the  culture  which  is  bestowed 
upon  it  renders  the  soil  very  fertile.  There  is  no  intermission  of 
vegetation  throughout  the  year.  March  and  April  are  the  months 
in  which  it  is  in  its  most  luxuriant  state.  It  is  very  much  burnt 
up  during  the  summer  months. 

The  surface  of  the  island  is  diversified  by  hills  of  slight  eleva- 
tion, and  vales.  There  is  neither  river  nor  lake,  but  numerous 
springs  exist  in  different  parts  of  the  island. 

The  range  of  the  thermometer  during  the  month  of  October, 
November,  December  and  January,  on  the  average  of  five  years, 
from  1830  to  1835  was  as  under  : — 


OCT. 

Nov. 

DEC. 

JAN. 

77 

69 

63| 

61 

Medium,  

7(U 

65 

59 

56£ 

Minimum. 

64 

61 

54* 

53 

Rain  is  of  very  rare  occurrence  in  Malta  during  the  summer; 
but  it  falls  in  spring  and  autumn  with  tropical  violence.  The 
autumnal  rains  usually  last  from  the  middle  of  September  to  the 
middle  of  October.  Rain  falls  most  heavily  during  the  night. 
Very  rarely  does  the  rain  continue  for  several  days  in  succession. 
There  is  occasionally  hail,  but  never  snow.  Heavy  falls  of  dew 
occur  sometimes  during  the  summer.  Fogs  are  rare  at  any  season. 

The  wind  which  has  procured  a  bad  name  for  Malta  with  stran- 
gers, is  the  southeast,  commonly  called  Sirocco.  It  is  a  hot,  humid, 


1  Malta  considered  with  reference  to  its  eligibility  as  a  Place  of  Residence 
for  Invalids. 


124         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

and  disagreeable  wind.  In  winter  it  is  not  frequent,  and  never 
oppressive.  It  is  most  prevalent  in  the  beginning  of  September. 
Strangers  in  general  are  affected  during  the  prevalence  of  the 
sirocco  with  great  lassitude  and  debility.  Persons  with  diseased 
lungs  suffer  more  or  less  from  it ;  but,  says  Dr.  Liddell,  "  I  am 
not  aware  of  any  mischief  that  it  produces  in  the  healthy  constitu- 
tion beyond  the  temporary  discomfort  that  it  occasions." 

The  climate  of  Malta  may  be  considered  pretty  equable,  the 
range  of  temperature  during  the  twenty-four  hours  seldom  exceed- 
ing 6°.  The  air  is  almost  always  dry  and  clear.  Gales  of  wind 
are  not  frequent,  but  Malta  may  be  said  to  be  a  windy  place,  parti- 
cularly in  spring.  Thunder  storms  are  common  during  the  rainy 
season.  The  fall  of  rain  is  supposed  to  be  about  fifteen  inches. 

Dr.  Liddell's  account  of  the  winter  climate  of  Malta  is  very 
favourable.  From  the  middle  of  October  to  the  middle  of  January 
he  thinks  it  can  scarcely  be  surpassed.  The  weather  is  delightful, 
with  the  exception  of  an  occasional  gregale,  or  northeast  wind, 
which  is  so  chilling,  that  during  its  existence,  invalids  should  either 
stay  at  home  or  seek  the  most  sheltered  walks  or  drives.  During 
the  period  mentioned,  the  atmosphere  is  generally  clear,  and  the 
weather  moderate  ;  and  the  island  is  usually  fanned  by  the  agree- 
able northwest  wind,  that  sweeps  along  the  channel  of  Malta,  over 
a  sea  at  the  temperature  of  720.1 

Towards  the  middle  of  January  the  weather  becomes  unsettled  ; 
February  and  March  are  usually  boisterous  and  rainy ;  April,  as 
elsewhere,  is  proverbially  variable ;  and  before  June,  phthisical 
patients  should  leave  the  island  to  avoid  the  sultry  summer  heat. 

The  diseases  in  which  Dr.  Liddell  has  observed  the  climate  of 
Malta  serviceable,  in  conjunction  with  the  important  preliminary 
sea-voyage  to  it,  have  been  asthma  connected  with  chronic  bron- 
chitis— scrofulous  swellings  and  eruptions,  dyspepsia  and  hypo- 
chondriasis,  and  that  atrophy  and  disordered  state  of  health,  which 
are  induced  by  over-active  therapeutics.  He  considers  the  climate 
to  be  peculiarly  conducive  also  to  the  health  of  the  aged.  Dr. 
Sankey  has  found  it  beneficial  in  chronic  rheumatism.  The  mor- 
tality amongst  Maltese  children  is  enormous,  from  their  scanty  and 
improper  food  ;  but  the  Maltese  women,  when  well  fed,  make  ex- 
cellent wet  nurses,  and  the  English  children  that  are  reared  by 
them,  or  by  their  own  mothers,  thrive  remarkably  well  in  Malta. 
The  diseases  of  children,  such  as  measles,  scarlet  fever,  and  hoop- 
ing cough,  are  comparatively  mild. 

When  phthisis  pulmonalis  occurs  among  the  English  at  Malta, 
Dr.  Liddell  thinks  it  is  more  rapid  in  its  course  than  in  England. 
In  regard  to  its  frequency  among  the  Maltese,  the  late  Dr.  Hennen, 
according  to  Dr.  Liddell,  fell  into  an  error,  which  has  been  per- 
petuatedln  the  Army  Medical  Reports.  It  is  the  confounding  of 

1  The  temperature  of  the  sea,  at  the  depth  of  ten  or  twelve  fathoms,  was 
ascertained  by  Capt.  Smyth  to  be  73°  to  76°  during  the  year. 


CLIMATES  OF  ITALY.  125 

pulmonary  consumption  with  Maltese  consumption,  a  disease  which 
has  no  necessary  reference  to  the  lungs.  Instead  therefore  of  six 
per  cent.,  cases  of  phthisis  pulmonalis,  according  to  Dr.  Liddell's 
tables,  do  not  exceed  three  per  cent.1 

The  immunity  of  Malta  from  any  endemic  disease,  the  ordinary 
good  health  enjoyed  by  the  natives,  and  by  the  English,  as  well  as 
by  persons  from  other  countries  resident  there,  and  the  actual  state 
of  the  weather  throughout  the  year,  have  given  a  character  for 
salubrity  to  the  climate.  But  from  the  statistical  tables  of  Major 
Tulloch,  it  appears,  that  even  as  regards  the  indigenous  inhabit- 
ants, Malta  is  by  no  means  so  healthy  as  Britain.  It  seems  to  enjoy 
only  the  average  salubrity  of  the  states  of  the  south  of  Europe. 

Strangers  reside  chiefly  in  Valetta,  the  capital  of  Malta,  which 
is  one  of  the  finest  towns  in  Europe.  It  is  built  on  a  declivity 
sloping  from  south  to  northeast.  The  principal  streets  run  north 
and  south,  and  are  swept  by  the  cold  northerly  winds.  The  houses 
are  excellent,  and  the  rooms  large  and  lofty. 

In  Valetta,  the  inns  are  numerous  and  good  ;  and  there  is  no 
longer  any  difficulty  in  finding  commodious  lodgings,  with  Turkey 
carpets  on  the  stone  flooring,  fires,  and  other  English  comforts. 
Country  houses,  with  gardens  and  orange  groves,  may  be  readily 
obtained  at  short  distances  from  the  city.  The  markets  are  plenti- 
fully supplied,  and  at  moderate  prices.  Valetta  is  abundantly  pro- 
vided with  excellent  water,  brought  from  a  spring  six  miles  off  by 
an  aqueduct.  The  other  places  in  the  island  are  mainly  supplied 
by  rain  water  collected  from  the  flat  roofs  of  the  houses,  and  kept 
in  cisterns  excavated  from  the  solid  rock.  The  principal  streets, 
which  are  kept  very  clean,  are  either  paved  or  macadamized,  and 
readily  dry  after  rain.  The  roads  leading  to  the  country,  and 
round  the  harbours  from  Valetta,  are  kept  in  good  condition,  but 
they  are  of  no  great  extent  or  variety.  Saddle  horses,  and  close  or 
open  carriages,  can  always  be  obtained  at  moderate  prices ;  and 
there  are  few  entire  days  in  the  winter  without  some  hours  of  sun- 
shine, in  which  delicate  invalids,  suitably  clothed,  may  not  take 
exercise  with  advantage  in  the  open  air,  on  foot,  on  horseback,  or 
in  a  carriage.  The  Maltese  boats  are  clean,  commodious,  and  safe, 
and  will  be  found,  during  the  numerous  calm  and  mild  days  of 
winter,  to  be  the  most  agreeable  vehicles  for  conveying  delicate 
invalids  round  the  harbours  and  fortifications,  in  which  the  great 
interest  of  Malta  consists.  The  most  desirable  places  in  Valetta, 
for  a  winter  residence,  are  those  with  a  southern  and  eastern  aspect, 
near  the  Barraccas,  looking  towards  Floriana,  or  into  the  great 
harbour  in  Strada  Levante. 

Casal  Lia,  about  three  miles  from  Valetta,  is,  in  Dr.  Liddell's 
opinion,  unexceptionable  as  a  residence  for  phthisical  invalids.  It 

1  The  investigations  at  present  in  course  by  my  talented  friend  Dr.  Gal- 
land,  Professor  of  Anatomy  and  Clinical  Surgery  in  the  University  of 
Malta,  will  soon  set  this  question  at  rest.  As  far  as  they  have  been  carried 
they  support  the  opinion  of  Dr.  Liddell. 


126         CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

is  well  sheltered,  and  is  contiguous  to  the  public  garden  of  Sant 
Antonio.  This  extensive  garden  has  a  southeastern  aspect,  and  is 
surrounded  by  a  high  wall,  and  the  walks,  which  are  paved  with 
stone,  speedily  dry  after  rain.  But  with  all  these  advantages,  Dr. 
Liddell  fears  that  suitable  accommodation,  with  good  English  com- 
forts for  invalids,  could  not  be  obtained  in  Casal  Lia,  although  the 
houses  are  generally  large  and  good. 

"  No  place,"  Dr.  Liddell  sums  up,  "  that  I  have  seen  in  the  south 
of  Europe,  can,  I  think,  compete  with  Malta,  for  a  mild,  dry,  brac- 
ing air,  in  November,  December,  and  part  of  January  ;  and,  during 
the  other  winter  and  spring  months,  I  think,  it  is  equal  to  any  of 
them.  I  have  been  at  them  all  in  winter,  except  Nice."1 

There  are  doubtless  on  the  shores  and  among  the  islands  of  the 
Mediterranean,  situations  possessing  climates  equal  to  those  of  the 
places  which  have  been  noticed ;  but  we  are  not  sufficiently  ac- 
quainted with  their  characters,  and  they  are  mostly  deficient  in 
those  requisites  which  are  as  essential  to  an  invalid  as  climate.  In 
giving  an  account  of  the  best  climates  of  the  Mediterranean,  we 
have  had  in  view  the  wants  of  the  more  delicate  class  of  invalids. 
To  those  who  are  sent  abroad  for  the  prevention  of  disease,  and 
the  improvement  of  their  health,  the  whole  shores  and  islands  of 
the  Mediterranean  are  open.  They  may  visit  the  south  coasts  of 
Spain,  Sicily,  the  Ionian  Islands,  Greece,  Syria,  and  Egypt ;  and, 
if  their  tour  is  conducted  with  judgment  and  discretion,  their 
health  may  be  more  improved  than  by  residing  at  any  one  of  the 
climates  mentioned.  But  the  more  delicate  invalid  must  rest  satis- 
fied with  such  limited  changes  as  have  been  pointed  out  in  the 
preceding  pages.8 


,-  SUMMER  RESIDENCE  ON  THE  CONTINENT. 

For  invalids  who  require  to  pass  several  winters  on  the  Conti- 
nent, it  becomes  a  matter  of  importance  to  select  a  place  where 
they  may  spend  the  intervening  summers  with  the  greatest  advan- 
tage to  their  health.  For  those  invalids  who  have  passed  the  winter 
in  Italy,  two  plans  present  themselves— either  to  recross  the  Alps, 
or  to  select  the  most  favourable  situation  in  that  country.  By  the 
first,  the  invalid  will  escape  the  oppressive  heat  of  an  Italian  sum- 
mer ;  by  the  latter,  he  will  avoid  the  inconveniences  of  a  long 
journey.  In  deciding  between  these,  in  individual  cases,  various 

1  In  drawing  up  the  preceding  account  of  Malta,  I  have  been  much  in- 
debted to  the  valuable  communications  from  Dr.  Liddell,  who  was  physi- 
cian to  the  Royal  Naval  Hospital  in  that  island  for  twelve  years,  and  whose 
statements  and  opinions  are  deserving  of  the  utmost  confidence.     I  would 
here  also  acknowledge  my  obligations  to  the   sensible  pamphlet  by  Dr. 
Sankey,  already  referred  to. 

2  See  article  Pulmonary  Consumption,  p.  30. 


SUMMER  RESIDENCE  ON  THE  CONTINENT.  127 

circumstances  will  require  to  be  considered,  which  admit  of  being 
noticed  here  only  in  a  very  general  manner. 

Consumptive  invalids  will  do  well  to  quit  Italy  ;  and  I  may  ob- 
serve that  I  comprehend  in  this  class,  not  only  those  actually 
labouring  under  phthisis,  but  all  such  as  are  threatened  by  it.  The 
summer  heat  of  Italy  will  disagree  with  both — in  proportion  to  the 
advanced  period  of  the  disease  in  the  former,  and  to  the  deranged 
state  of  the  general  health  in  the  latter.  In  both  cases  we  generally 
find  a  weak  and  relaxed  state  of  the  constitution,  accompanied) 
very  often,  with  a  morbid  sensibility  of  the  nervous  system,  in 
which  great  heat  is  always  injurious.  And  when  symptomatic 
fever  or  morning  perspirations  have  shown  themselves,  these 
afford  still  stronger  reasons  against  a  summer  residence  south  of 
the  Alps. 

Among  this  class  of  invalids  some  exceptions  may,  however,  be 
found.  Torpid  constitutions,  in  which  there  is  little 'nervous  sensi- 
bility, and  little  disposition  to  febrile  excitement,  with  a  defective 
state  of  the  cutaneous  secretions,  and  a  ri^id  rather  than  a  relaxed 
state  of  fibre,  may  even  derive  advantage  from  a  summer  passed  in 
one  of  the  more  healthy  situations  in  Italy. 

But  the  greater  number  of  invalids  who  have  derived  benefit 
from  the  Italian  climate,  during  the  winter,  will  do  well  to  quit  it 
in  the  summer.  This  remark  will  apply  more  especially  to  those 
who  labour  under  diseases  of  the  nervous  system,  depending  upon, 
or  connected  with,  cerebral  congestion ;  indeed,  very  few  of  this 
class  of  invalids  should  venture  to  pass  even  the  winter  in  Italy, 
without  carefully  adapting  their  regimen  to  the  nature  of  the  cli- 
mate. Likewise,  in  cases  of  irritation  of  the  mucous  membrane  of 
the  digestive  organs,  and  in  congestions  of  the  abdominal  viscera, 
with  a  deranged  state  of  the  functions  of  the  liver,  or  a  disposition 
to  dysentery,  the  whole  south  of  Europe  will  disagree  during  the 
summer. 

The  places  principally  resorted  to  by  invalids,  who  pass  the  sum- 
mer in  Italy,  are  Naples,  and  its  vicinity ;  Sienna,  and  the  Baths 
of  Lucca.  These  are  the  most  eligible  summer  residences  south 
of  the  Apennines :  nor  am  I  aware  that  any  place  superior  to  them 
in  point  of  climate,  and  possessing  the  necessary  accommodations 
for  invalids,  is  to  be  found  in  the  north  of  Italy. 

The  Vomero  and  the  Capo  di  Monte,  in  the  immediate  vicinity 
of  Naples,  afford  good  situations  for  summer  residences.  Of  the 
more  distant  places,  Sorento,  Castelamare,  and  the  island  of  Ischia 
are  the  best.  Sorento  appears  to  be  the  coolest  of  these ;  for  which 
it  is  chiefly  indebted  to  its  peninsular  form,  being  a  long  narrow 
strip  of  land,  having  the  bay  of  Naples  on  one  side,  and  the  gulf 
of  Salerno  on  the  other. 

Castelamare  partakes  more  of  the  climate  of  the  Apennines,  and 
affords  also  their  usual  shelter  of  chestnut  trees.  The  air  is  less 
dry  than  at  Sorento.  From  its  northwestern  aspect,  and  the  moun- 
tains which  rise  immediately  behind  it,  this  place  enjoys  a  long 


128        CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

morning  shade ;  but  its  full  exposure  to  the  setting  sun  renders  the 
evenings  often  oppressively  hot. 

At  Cava,  between  Naples  and  Salerno,  the  air  is  said  to  be  drier 
and  cooler  than  at  any  of  these  places. 

Sienna  affords  a  healthy  summer  residence  for  persons  who  are 
not  very  liable  to  suffer  from  rapid  changes  of  temperature,  for  such 
often  occur  here  during  the  summer,  owing  to  the  high  and  ex- 
posed situation  of  the  place.  Sienna  is  considerably  cooler  in  the 
summer,  and  much  colder  in  the  winter,  than  Naples,  Rome,  or 
Pisa.  The  mean  annual  temperature  is  55°.60  ;  being  6°  less  than 
Naples,  and  only  about  5°  more  than  London  ;  but  this  arises  from 
the  coldness  of  its  winter,  which  is  only  l°.38  warmer  than  that  of 
London.  Its  summer  temperature  is  about  the  same  as  that  of 
Capo  di  Monte  at  Naples,  but  3°  warmer  than  that  of  the  Baths  of 
Lucca.  Its  daily  range  of  temperature  is  very  great.  It  is  a  dry 
and  healthy  climate,  and  altogether  a  safe  summer  residence  ;  and 
for  nervous  relaxed  people,  it  forms  a  better  summer  retreat  than 
either  Naples  or  the  Baths  of  Lucca,  and  like  the  latter  place  is 
exempt  from  mosquitoes.  For  persons  disposed  to,  or  labouring 
under  pulmonary  disease,  however,  Sienna  is  an  unfavourable  cli- 
mate, at  all  seasons. 

Baths  of  Lucca. — This  little  watering  place,  situated  among  the 
Apennines  near  Lucca,  is  much  frequented  during  the  summer ; 
partly  on  account  of  its  mineral  waters,  but  more  on  account  of  the 
coolness  of  the  situation.  This  last  quality  is  its  chief  attraction 
to  strangers.  The  mean  temperature  of  the  summer  here  is  only 
about  6°  higher  than  the  summer  of  London.  In  the  middle  of  the 
day,  however,  the  heat  is  often  oppressive  ;  but  the  evenings  arid 
nights  are  cool  and  pleasant,  and  there  are  no  mosquitoes.  June, 
July,  and  August,  constitutes  the  proper  season  at  this  place. 
Earlier  than  June,  and  after  August,  the  air  is  damp,  and  unsuit- 
able to  delicate  people.  There  is  some  variety  of  situation  ;  the 
Bagni  Caldi  are  on  the  brow  of  a  high  hill ;  the  Bagni  alia  Villa 
are  partly  on  the  declivity  of  a  hill,  and  partly  on  a  plain  ;  and  the 
Pont'  a  Seraglio  is  in  a  valley  on  the  banks  of  the  little  river  Lima. 
The  Bagni  Caldi  is  the  driest  situation,  and,  when  protected  from 
the  sun,  also  the  coolest.  The  vicinity  of  the  Bagni  alia  Villa  is 
warmer,  but  quieter  and  more  retired.  The  accommodations, 
which  have  been  greatly  extended  of  late  years  at  all  these  places, 
are  pretty  good. 

The  rides  on  horseback  about  Lucca  are  beautiful  and  varied  ; 
but  there  is  only  one  or  two  drives  for  those  who  require  carriage 
exercise. 

The  preference  to  be  given  to  any  one  of  the  places  mentioned, 
will  depend  upon  the  particular  circumstances  of  the  case.  Where 
sea-air  is  known  to  agree  well,  and  where  passive  exercise  on  the 
water,  or  sea-bathing  are  advisable,  some  of  the  cooler  situations 
in  the  neighbourhood  of  Naples  afford  the  best  residences.  On  the 
other  hand,  where  there  is  much  nervous  sensibility,  and  when  the 


SUMMER  RESIDENCE  ON  THE  CONTINENT.  129 

effects  of  the  sirocco  are  likely  to  prove  injurious,  Naples  and  its 
vicinity  ought  to  be  avoided.  The  Baths  of  Lucca  and  Sienna 
should  be  preferred  by  such  invalids,  particularly  the  former,  which 
is  a  very  delightful  summer  residence. 

The  accommodations  for  strangers  at  Sorento  and  Castelamare 
have  been  greatly  increased  of  late  years — walks  and  drives  formed, 
and  bathing  machines  constructed.  An  English  physician  generally 
resides  at  these  places  during  the  summer. 

The  island  of  Ischia  is  also  resorted  to  as  a  summer  residence, 
and  it  may  deserve  a  preference  by  some  invalids,  on  account  of 
its  mineral  waters.  These  are  very  abundant ;  indeed  almost  all 
the  water  of  the  island  is  more  or  less  thermal,  and  mineralised. 
Dr.  Adair  Crawford,  who  resided  a  summer  in  Ischia,  found  that 
the  heat  during  the  day  was  moderated  by  regular  sea  breezes,  and 
that  the  nights  were  very  pleasant. 

Switzerland. — Although  I  have  not  hesitated  in  advising  inva- 
lids generally,  and  consumptive  patients  in  particular,  to  quit  Italy 
during  the  summer,  I  do  not  feel  the  same  confidence  in  pointing 
out  an  unexceptionable  residence  elsewhere,  more  especially  for 
the  latter,  during  that  season.  Switzerland  in  point  of  convenience 
certainly  affords  one  very  eligible ;  but  much  caution  and  prudence 
are  required  on  the  part  of  invalids  labouring  under  pulmonary 
affections  who  remain  there.  The  alternations  of  temperature  are 
rapid  and  very  considerable.  The  difference  between  the  day  and 
night  is  great,  and  there  is  often  a  sharpness  in  the  air  which  proves 
irritating  to  sensitive  invalids. 

Invalids  may  pass  the  summer  in  Switzerland  with  safety,  pro- 
vided they  use  ordinary  prudence,  and  are  careful  to  avoid  unne- 
cessary exposure  to  the  vicissitudes  of  the  weather.  They  should 
also  content  themselves  with  such  excursions  only  as  do  not  cause 
them  to  be  over-fatigued,  or  heated  at  one  moment,  and  exposed, 
while  in  a  state  of  perspiration,  perhaps,  to  a  cold  breeze  the  next ; 
a  thing  which  is  constantly  occurring  during  mountain  excursions 
in  Switzerland.  They  should  neither  take  long  fatiguing  walks, 
nor  climb  steep  mountains.  They  must  not  attempt  to  do  every 
thing,  and  see  every  thing,  like  their  more  robust  and  healthy 
friends.  In  a  word,  they  should  not  for  a  moment  lose  sight  of  the 
great  object  for  which  they  are  abroad,  viz.,  the  preservation  and 
improvement  of  their  health.  Severe  attacks  of  fever,  and  other 
acute  diseases,  are  not  uncommon  consequences  of  imprudence  of 
the  kind  alluded  to,  even  among  the  most  robust. 

It  will  not,  I  hope,  be  supposed  from  any  thing  now  stated,  that 
I  wish  to  throw  obstacles  in  the  way  of  young  persons,  threatened 
with  consumption,  taking  exercise  in  the  open  air.  This  is  so  far 
from  being  my  intention,  that  I  think  such  persons  can  scarcely  be 
too  much  in  the  open  air.  Ail  I  wish  to  inculcate  is,  that  they 
should  be  careful  not  to  convert  the  best  of  all  preventives  into  a 
source  of  evil.  For  this  class  of  invalids,  riding  on  horseback  is 
of  all  others  the  most  favourable.  I  am  convinced  from  experience, 
2— b  9  dark 


130         CLARK  ON  THE  §ANATIVE  INFLUENCE  OP  CLIMATE. 

that  frequent  and  gentle  motion  through  a  mild  atmosphere  is  one 
of  the  most  soothing  and  invigorating  measures  which  we  possess 
for  allaying  an  irritated  and  congested  state  of  the  mucous  mem- 
branes of  the  lungs,  and  improving  the  general  health. 

The  borders  of  the  lake  of  Geneva  afford,  I  think,  the  best  situa- 
tions for  a  summer  residence  in  Switzerland;  and  the  neighbour- 
hood of  Geneva  is  altogether  the  least  exceptionable.  Vevey  is 
very  hot  during  July  and  August.  The  higher  situations  about 
Lausanne  are  exposed  to  the  north  winds,  especially  the  cutting 
Bise,  which  frequently  blows  in  the  evenings  and  nights  after  the 
hottest  days  of  summer,  producing  a  great  and  often  sudden  change 
of  temperature.  The  low  grounds  between  Lausanne  and  the  lake 
are  close  and  hot. 

The  subjects  of  pulmonary  affections,  who  pass  the  summer  in 
Switzerland,  may  try  the  effects  of  a  course  of  grapes,  "  Cure  de 
Raisins?  a  remedy,  as  already  remarked,  in  high  estimation  in 
several  parts  of  the  Continent ;  but  on  this  point  the  invalid  will, 
of  course,  be  directed  by  a  physician  on  the  spot. 

I  cannot  close  these  few  remarks  on  the  choice  of  a  summer  resi- 
dence without  recalling  the  attention  of  the  reader  to  the  cautions 
I  have  already  given  on  the  subject  of  traveling.  Unless  a  journey 
in  hot  weather  is  conducted  with  great  circumspection,  the  irrita- 
tion and  excitement  arising  from  it  in  susceptible  systems,  especially 
where  any  organ  is  in  a  state  of  chronic  disease,  however  slight  in 
degree,  will  do  more  mischief  than  any  advantage  that  can  be 
derived  from  a  short  residence  in  the  best  climate,  or  from  the  use 
of  the  most  valuable  mineral  waters.  It  will  be  more  advisable  for 
such  an  invalid  to  remain  quietly  in  a  situation,  even  though  not 
the  most  suitable  to  him,  (but  the  inconveniences  of  which  may, 
in  a  great  measure,  be  obviated  by  prudence)  than  expose  himself 
to  the  danger  of  having  his  disease  increased  by  a  journey  in  hot 
weather. 


ATLANTIC  CLIMATE. 

Various  islands  in  the  Atlantic  have  been  recommended  as 
affording  favourable  winter  retreats  for  invalids  ;  Madeira,  the 
Canaries,  and  the  Azores,  in  the  Eastern,  and  the  Bahamas  and 
Bermudas  in  the  Western  Atlantic. 

It  is  to  be  remarked,  that  the  climate  of  North  America  differs 
materially  in  its  physical  characters  from  that  of  Europe  and  Africa. 
The  range  of  temperature  is  much  greater ;  the  changes  more 
rapid  and  extensive  ;  the  summer  heat  much  higher,  and  the  win- 
ter cold  much  more  intense  under  the  same  parallels  of  latitude,  on 


ATLANTIC  CLIMATES. 


131 


the  American  shores  than  on  those  of  Europe.1  The  western  is 
also  more  subject  to  storms  than  the  eastern  Atlantic.  We  shall 
find  a  corresponding  difference  in  the  climate  of  the  islands  under 
consideration,  according  as  they  approach  the  American  or  African 
Continents. 

EASTERN  ATLANTIC. 

The  islands  of  the  eastern  Atlantic,  while  they  differ  consider- 
ably in  the  physical  qualities  of  their  climate,  differ  still  more  re- 
markably in  their  structure,  and  external  conformation,  from  those 
of  the  western  Atlantic.  The  latter  are  low,  arid,  and  mostly 
barren  rocks,  destitute  of  springs  ;  the  former,  on  the  contrary,  are 
lofty,  and  abundantly  supplied  with  water,  and  covered  with  luxu- 
riant vegetation ;  circumstances  which,  independently  of  their 
geographical  position,  influence  the  climate  in  a  very  material 
degree. 

MADEIRA. 

I  shall  commence  my  survey  of  the  Atlantic  Islands  with  Ma- 
deira. It  is  the  most  important  and  most  frequented  by  invalids  ; 
and  the  character  of  its  climate  being  the  most  fully  determined,  it 
will  serve  as  a  standard  by  which  to  estimate  the  climates  of  the 
other  islands. 

Madeira  has  been  long  held  in  high  estimation  for  the  mildness 
and  equability  of  its  climate,  and  we  shall  find  on  comparing  this 
with  the  climates  of  the  most  favoured  situations  on  the  continent 
of  Europe,  that  the  character  is  well  founded. 

The  mean  annual  temperature  of  Funchal,  the  capital  of  the 
island,  is  64°56,  being  about  5°  only  above  that  of  the  Italian  and 
Provencal  climates.  This  very  moderate  mean  temperature,  rela- 
tively to  its  low  latitude,  arises,  however,  from  the  summer  at 

1  The  climate  of  North  America  is  of  that  class  which  Buffon  has  desig- 
nated Excessive  Climates;  that  is,  having  exceedingly  hot  summers,  and 
intensely  cold  winters,  consequently  an  extensive  annual  range  of  tempera- 
ture. The  following  comparison  of  a  few  places,  having  nearly  the  same 
mean  annual  temperature  in  the  Eastern  and  Western  hemispheres,  will 
suffice  to  show  this:— 


PLACES. 

Mean 
Ann. 
Temp. 

Temp, 
of 
Summer. 

Temp, 
of 
Winter. 

Ditf.  of 
Winter 
and 
Summer. 

Paris,           ..... 

5i°4 

66°0 

38°0 

28°0 

Cambridge,  Amer. 

50°4 

70°5 

34°0 

36°0 

St.  Maloes, 
Cincinnati, 

54°5 
53°7 

66°0 
72°9 

42°0 
32°9 

24°0 
40°0 

Nantes, 
New  York, 

55°6 
53°8 

70°7 
70°2 

42°2 
29°8 

28°4 
40°0 

Bourdeaux, 
Philadelphia, 

56°5 
54°9 

70°7 
73°9 

42°  1 
32°2 

28°6 
41°7 

132        CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

Madeira  being  proportionally  cool.  For,  whilst  the  winter  is  20° 
warmer  than  at  London,  the  summer  is  only  7°  warmer  ;  and 
whilst  the  winter  is  12°  warmer  than  in  Italy  and  Provence,  the 
summer  is  nearly  5°  cooler.  The  mean  annual  range  of  tempera- 
ture is  only  14°,  being  less  than  half  the  range  of  Rome,  Pisa,  Na- 
ples, and  Nice.  The  heat  is  also  distributed  throughout  the  year 
with  surprising  equality,  so  that  the  mean  difference  of  the  tem- 
perature of  successive  months  is  only'2°41 ;  this  at  Rome  is  4°39, 
at  Nice  4°74,  at  Pisa  5°75,  and  at  Naples  5°08. 

Whilst  there  is  much  equality  in  the  distribution  of  temperature 
throughout  the  year,  there  is  not  less  in  the  progression  of  tempera- 
ture for  the  day,  the  mean  range  for  the  twenty-four  hours  being 
10°  by  the  register  thermometer,  while  at  Rome  it  is  10°,  at  Na- 
ples 13°,  at  Nice  9°,  by  the  common  thermometer,  which  gives  the 
extremes  observed  during  the  day  only. 

The  steadiness  of  temperature  from  day  to  day  also  exceeds  that 
of  all  the  other  climates.  In  this  respect,  it  is  not  half  so  variable 
as  Rome,  Nice,  or  Pisa,  and  is  only  about  one  third  as  variable  as 
Naples.  The  degree  of  variableness  from  day  to  day  at  Madeira, 
is  1°11 ;  at  Rome  it  is  2°80  ;  at  Nice  2°33  ;  and  at  London  4°01. 

The  annual  range  of  atmospheric  pressure  is  also  very  small, 
being  about  the  same  as  that  of  Rome  and  Naples. 

Nearly  the  same  quantity  of  rain  falls  annually  at  Madeira  as  at 
Rome  and  Florence,  but  at  Madeira  there  are  only  73  days  on 
which  any  rain  falls,  while  at  Rome  there  are  117.  The  rain  at 
Madeira  falls  at  particular  seasons,  chiefly  in  the  autumn,  leaving 
the  atmosphere,  in  general,  dry  and  clear  during  the  remainder  of 
the  year. 

From  this  comparative  view  of  the  climate  of  Madeira,  it  must 
be  readily  perceived,  how  great  the  advantages  are  which  this 
island  presents  to  certain  invalids  over  the  best  climates  on  the 
continent  of  Europe.  It  is  warmer  during  the  winter,  and  cooler 
during  the  summer ;  there  is  less  difference  between  the  tempera- 
ture of  the  day  and  night,  between  one  season  and  another,  and 
between  successive  days :  it  is  almost  exempt  from  keen,  cold 
winds,  and  enjoys  a  general  steadiness  of  weather  to  which  the 
best  of  these  places  are  strangers.  During  the  summer,  the  almost 
constant  prevalence  of  northeasterly  winds,  especially  on  the  north, 
and  the  regular  sea  and  land  breezes  on  the  south  side  of  the  island, 
maintain  the  atmosphere  in  a  temperate  state.  The  sirocco,  which 
occurs  two  or  three  times,  at  most,  during  the  season,  and  then 
continues  for  a  few  days  only,  (seldom  more  than  three,)  some- 
times raises  the  thermometer  in  the  shade  to  900.1  With  this 
exception,  the  summer  temperature  is  remarkably  uniform,  the 
thermometer  rarely  rising  above  80°.  In  consequence  of  the  regu- 
lar sea-breezes,  the  heat  is  not  so  oppressive  as  that  of  the  summer 

1  The  late  Dr.  Heineken  never  knew  it  laise  the  thermometer,  in  the 
shade,  above  85°. 


ATLANTIC  CLIMATES.  133 

in  England  often  is.  Close,  sultry  days  are  little  known  in  Ma- 
deira, and  there  is  neither  smoke  nor  dust  to  impair  the  purity  of 
the  atmosphere.  Such,  indeed,  is  the  mildness  of  the  summer  at 
Madeira,  that  a  physician,  himself  an  invalid,  who  resided  for  some 
time  on  the  island  on  account  of  his  health,  doubted  whether  this 
season  was  not  more  favourable  to  pulmonary  invalids  than  the 
winter.1 

Autumn  is  the  rainy  season  ;  and  towards  the  end  of  September, 
or  the  beginning  of  October,  the  rains  commence,  accompanied 
with  westerly  or  southwesterly  winds.  In  November  the  weather 
clears  up,  and  generally  continues  fine  and  mild  till  the  end  of  De- 
cember. About  this  time  some  snow  usually  falls  on  the  moun- 
tains, and  rain  at  Funchal,  attended  by  northwest  winds,  and 
the  weather  continues  more  or  less  damp  through  January  and 
February;  but  fog  is  never  seen,  and  even  during  this,  the  winter, 
the  thermometer  at  sun-rise  is  rarely  ever  found  below  50°. 

The  spring  at  Madeira,  as  at  every  other  place,  is  the  most 
trying  season  for  the  invalid,  and  will  require  even  there  a  corre- 
sponding degree  of  caution  on  his  part.  In  March,  winds  are  fre- 
quent, and  April  and  May  are  showery. 

The  mild  character  of  the  climate  appears  to  be  accompanied 
with  a  corresponding  degree  of  health  in  the  inhabitants  of  Madeira. 
The  peasantry,  though  hard  worked  and  badly  fed,  are  a  fine, 
healthy,  and  robust  race.  "  The  lower  orders  of  Madeira,"  says 
Captain  Basil  Hall,  "appear  to  enjoy  a  prodigious  advantage  over 
the  higher  classes  in  personal  appearance — a  distinction  they  owe 
no  doubt,  to  those  temperate  and  laborious  habits  of  life,  which 
probably  they  consider  as  any  thing  but  good  gifts  of  fortune.  To 
our  superficial  glance,  at  least,  the  peasantry  of  that  happy  island 
seemed  amongst  the  most  cheerful  people  we  had  yet  met  with."2 
This  island  is  almost  exempt  from  the  diseases  peculiar  to  warm 
climates,  and  little  subject  to  many  of  those  which  are  common  in 
more  northerly  countries.  Intermittent  and  remittent  fevers  arc 
said  never  to  occur,  and  continued  fevers  are  rare ;  croup  seems  to 
be  unknown  ;  calculous  disorders  are  very  unfrequent.  The  more 
prevalent  diseases  are  cutaneous  affections.  Apoplexy  is  also  a 
very  frequent  disease.  Bowel  complaints  are  very  common,  and 
often  fatal ;  and  dysentery  is  said  to  be  frequently  epidemic  ;  indeed 
this  disease  maybe  said  to  be  almost  endemic,  among  the  labouring 
classes;  nor  need  this  excite  our  surprise,  when  we  consider  their 
mode  of  living,  which  will  be  presently  mentioned. 

With  respect  to  the  prevalence  of  consumption  among  the  na- 
tives of  Madeira,  there  is  a  difference  of  opinion  among  those  who 
have  had  the  best  opportunities  of  observing.  "  Though  so  highly 
beneficial  in  this  disease,  with  the  natives  of  other  countries,"  says 

1  See  an  excellent  paper  by  the  late  Dr.  Heineken,  in  the  Medical  Reposi- 
tory, vol.  xxii.  1824. 

2  Fragments  of  Voyages  and  Travels,  p.   154.     First  Series.    New  edi- 
tion, 1840. 


134        CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

Dr.  Gourlay,  "  it  is  not  to  be  concealed  that  no  malady  is  more 
prevalent  here  than  phthisis,  with  the  natives  of  the  island."1  Dr. 
Heineken's  observation  leads  him  to  a  contrary  conclusion.  "  It 
has  been  asserted,"  says  this  gentleman,  "  that  no  malady  is  more 
prevalent  than  phthisis  with  the  natives  of  Madeira  ;  but,  as  far  as 
my  own  personal  experience  and  the  result  of  my  inquiries  go,  I 
incline  to  a  contrary  conclusion."2 

Since  the  first  edition  of  this  work  was  published,  I  have  made 
particular  inquiries  respecting  the  frequency  of  consumption  in 
Madeira,  and  I  am  satisfied  from  the  information  which  I  have 
received,  that  tubercular  consumption  (with  which  alone  we  have 
to  do  here)  is  a  rare  disease,  compared  with  what  it  is  in  more 
northern  climates.  "With  respect,"  says  Dr.  Renton,  "  to  the  ques- 
tion relative  to  the  frequency  of  consumption  among  the  natives, 
Dr.  Gourlay  (if  he  alluded  to  tubercular  disease)  has  greatly  over- 
rated it.  Tubercular  phthisis  occurs  more  frequently,  perhaps, 
than  might,  a  priori,  have  been  expected  in  such  a  climate  ;  and  I 
have  even  known  it,  in  a  few  instances,  sweep  off  nearly  whole 
families.  But  it  is  only  necessary  to  take  a  cursory  view  of  the 
habits  and  circumstances  of  the  natives,  to  see  that  they  enjoy  a 
singular  degree  of  exemption  from  a  disease,  to  the  ordinary  causes 
of  which  a  large  proportion  of  them  is  constantly  exposed." 

The  lower  classes  in  Madeira  are  hard-worked  and  miserably 
nourished;  their  food  consists  chiefly  of  crude  vegetables  and  hard- 
salted  fish ;  they  are  badly  clothed,  and  worse  lodged  ;  their  habita- 
tions are  low  miserable  huts,  and  their  beds  consist  of  pallets  of 
straw,  raised  a  foot  or  two  only  from  the  ground,  damp  during  nine 
months  of  the  year.  That  diseases  of  the  lungs  should  be  frequent 
under  such  circumstances  is  not  surprising;  and  as  these  are  gene- 
rally neglected,  or  badly  treated,  they  often  prove  fatal  in  a  chronic 
form  simulating  phthisis.  But  even  if  tubercular  consumption  were 
a  frequent  occurrence  under  the  circumstances  which  we  have 
stated,  it  would  afford  no  reasonable  ground  of  objection  to  the 
climate  of  Madeira,  for  persons  exempted  from  such  palpable  causes 
of  disease. 

In  my  inquiries  respecting  the  influence  of  the  climate  of  Madeira 
on  disease,  I  shall  confine  myself  to  consumption,  which  is,  indeed, 
almost  the  only  disease  on  account  of  which  Madeira  has  been 
resorted  to.  As  I  never  resided  at  this  island,  I  must  rely  on  the 
information  and  opinions,  which  I  have  derived  from  other  sources. 
On  this  subject,  however,  I  have  obtained  so  much  assistance  from 
Dr.  Renton,  who  has  long  resided  in  the  island,  and  from  the  late 
Dr.  Heineken,  who  spent  the  last  nine  years  of  his  life  there,  on 
account  of  a  pulmonary  disease,  that  the  utmost  reliance  may  be 
placed  on  the  following  observations.  Both  these  gentlemen  have 

1  Observations  on  the  Natural  History.  Climate,  and  Diseases  of  Madeira. 
By  William  Gourlay,  M.  D.   1811. 
8  Op.  Citat. 


ATLANTIC  CLIMATES.  135 

published  valuable  papers  on  the  climate  of  Madeira,  and  its  in- 
fluence on  consumptive  patients.  Their  opinions  regarding  the 
propriety  of  sending  such  patients,  in  the  advanced  stage  of  the 
disease,  to  this  island,  are  in  perfect  accordance  with  those  I  pub- 
lished on  the  subject,  with  reference  to  the  Continent,  twenty  years 
ago.1  And  the  results  of  their  experience,  given  below,  confirm 
in  the  most  conclusive  manner,  the  principles  which  are  incul- 
cated in  this  work,  respecting  the  proper  period  of  sending  con- 
sumptive invalids  abroad.  They  show  the  necessity  of  adopting 
change  of  climate  as  a  means  of  preventing^  rather  than  of  curing 
consumption.  Dr.  Renton,  in  a  sensible  paper  published  in  the 
Edinburgh  Medical  and  Surgical  Journal,2  makes  some  judicious 
remarks  on  the  "  inutility,  not  to  say  cruelty"  of  sending  patients  in 
the  advanced  stages  of  consumption,  to  Madeira. 

I  give  the  following  interesting  and  instructive  table  from  Dr. 
Renton's  paper.  It  is  drawn  up  from  the  cases  of  which  he  had 
kept  notes,  during  the  preceding  eight  years. 

Cases  of  CONFIRMED  PHTHISIS  .         .         .47 

Of  these  died  within  six  months  after  their  arrival  at  Madeira  32 

Went  home  in  summer,  returned,  and  died,         ...  6 

Left  the  island,  of  whose  death  we  have  heard    ...  6 

Not  since  heard  of,  probably  dead       ....  3 

Total    47 

Cases  of  INCIPIENT  PHTHISIS     ....         35 

Of  these  there  left  the  island  much  improved,  and  of  whom  we 

have  had  good  accounts 26 

Also  improved,  but  not  since  heard  of         ....  5 

Have  since  died 4 

Total     35 

"  In  the  cases  marked  Confirmed  Phthisis,  there  were  copious 
purulent  expectoration,  diarrhoea,  &c.,  and  almost  all  of  them 
terminated  fatally. 

"  Some  of  those  marked  Incipient  Phthisis  were  probably  not 
fully  entitled  to  an  appellation  so  ominous.  The  subjects  were 
generally  young  people  who  were  said  to  have  'overgrown  them- 
selves,' and  who  had  been  liable  in  England  to  inflammatory  attacks, 
having  cough,  &c.  Others  had  suffered  from  neglected  or  mistreated 
inflammation,  and  in  many  there  was  a  strong  family  predisposition 
to  pulmonary  disease.  Most  of  them,  I  have  little  doubt,  would  now 
have  been  in  their  graves,  but  for  the  precautionary  measure  which 
was  adopted." 

1  See  "  Notes  on  the  Climate  of  France  and  Italy,"  &c.,  1820. 

2  Vol.  xxvii.  1817. 


136         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

With  respect  to  the  consumptive  cases  which  are  likely  to  derive 
advantage  from  a  residence  at  Madeira,  Dr.  Renton  further  remarks, 
"  When^it  (consumption)  has  proceeded  to  any  considerable  extent, 
I  should  consider  it  the  duty  of  a  medical  attendant  not  only  not  to 
advise  the  adoption  of  such  a  measure,  but  most  earnestly  to  dis- 
suade from  it  those  who,  from  hearsay  evidence  of  the  recovery  of 
persons  in  circumstances  similar  to  their  own,  may  feel  disposed  to 
fly  to  it  as  a  last  resource. 

"  That  great  and  lasting  benefit  is  to  be  derived  even  from  a  tem- 
porary residence  in  this  climate,  which  is  probably  inferior  to  no 
other  in  cases  where  pulmonary  disease  is  merely  threatened,  or 
where  strong  family  predisposition  to  it  exists,  many  living  exam- 
ples sufficiently  prove.  But  even  under  such  comparatively  favour- 
able circumstances,  it  ought  to  be  strongly  impressed  on  the  mind 
of  the  invalid,  that  half  measures  are  worse  than  useless,  and  that 
no  advantage  is  to  be  derived  from  climate,  however  fine,  unless  it 
be  seconded  by  the  utmost  caution  and  prudence  on  his  part." 

The  result  of  Dr.  Heineken's  observations  is  quite  in  accordance 
with  that  of  Dr.  Renton. 

Of  the  thirty-five  cases  reported  by  Dr.  Heineken,  several  died 
before  they  reached  the  island,  three  within  a  month  of  their  land- 
ing, and  five  or  six  in  about  six  months.  Of  forty-seven  cases  of 
the  same  class  of  invalids  in  Dr.  Renton's  report,  more  than  two 
thirds  died  within  six  months  of  their  arrival  in  the  island.  This 
is  a  melancholy  picture  of  the  progress  of  consumption  under  all 
the  advantages  of  the  mildest  climate ;  it  shows,  in  a  striking  point 
of  view,  the  necessity  of  discrimination  in  sending  patients  to  Ma- 
deira, and  ought  to  impress  medical  men  with  a  deep  feeling  of  the 
heavy  responsibility  which  they  take  upon  themselves  in  deciding 
on  a  question  of  such  importance.  By  far  the  greater  number  of 
the  patients,  above  referred  to,  ought  never  to  have  left  their  own 
country;  the  advanced  period  of  their  disease  could  leave  no  rea- 
sonable prospect  of  benefit  from  such  a  measure. 

The  result  of  the  cases  sent  to  Madeira  at  the  proper  period  is 
very  different.  Of  thirty-five  cases  of  incipient  or  threatened 
phthisis,  twenty-six  were  much  improved,  and  probably  a  large 
proportion  of  them  were  ultimately  saved. 

While,  therefore,  the  result  of  sending  patients  in  an  advanced 
stage  of  consumption  to  Madeira  shows  the  inutility  of  such  a  mea- 
sure, to  say  the  least  of  it,  the  effects  of  the  climate  in  incipient 
cases,  and  on  those  threatened  with  the  disease,  are  highly  encou- 
raging, and  should  lead  medical  men  to  recommend  such  a  measure 
at  the  time  only  when  it  promises  benefit. 

The  following  table,  for  which  I  am  also  indebted  to  Dr.  Renton, 
while  it  shows  the  same  result  as  regards  confirmed  cases  of  con- 
sumption sent  to  Madeira,  exhibits  the  good  effects  of  sending 
proper  cases.  It  is  also  satisfactory  to  see  that  much  the  larger 
proportion  of  cases  now  sent  are  of  the  latter  description. 


ATLANTIC  CLIMATES.  137 

Number  of  CONSUMPTIVE  INVALIDS  who  have  arrived  here  from 
1st  January,  1838  to  31st  May,  1840      .  .  182 

With  TUBERCULOUS  LUNGS         ...         56 

Died  here 30 

Left  the  island  22 

Still  here    .  .4 

56 
Threatened  with  PULMONARY  DISEASE        .       10S 

Remained  free  from  symptoms     .         .  .         .         93 

Fell  off .  13 

Lost  sight  of       ....  ...  2 

108 

For  some  time  after  the  publication  of  the  first  edition  of  this 
work.  Dr.  Renton  remarked  that  the  proportion  of  invalids  whose 
cases  admitted  of  benefit  from  the  climate  was  greatly  augmented ; 
but  I  have  reason  to  fear  that  the  successful  issue  of  such  cases  has 
encouraged  many  to  go  to  Madeira  who  would  have  found  it  better 
to  remain  at  home. 

When  we  take  into  consideration  the  mildness  of  the  winter,  and 
the  coolness  of  the  summer,  tog-ether  with  the  remarkable  equality 
of  the  temperature  during  the  day  and  night,  as  well  as  throughout 
the  year,  we  may  safely  conclude  that  the  climate  of  Madeira  is  the 
finest  in  the  northern  hemisphere. 

The  salubrity  of  this  favoured  island  also,— its  almost  total 
exemption  from  endemic  diseases,  and  the  general  mildness  of  the 
ordinary  complaints,  from  which  no  climate  rior  situation  is  exempt, 
contribute  to -render  Madeira  a  very  desirable  residence  for  all  inva- 
lids who  are  in  a  condition  to  be  benefited  by  a  mild  and  equable 
climate. 

There  is  no  place  on  the  continent  of  Europe  with  which  I  am 
acquainted,  where  the  pulmonary  invalid  could  reside  with  so  much 
advantage  during  the  whole  year  as  in  Madeira.  On  this  subject  I 
have  already  cited  Dr.  Heineken's  opinion,  which  is  of  the  greater 
weight,  as  he  himself  resided  in  Madeira  in  consequence  of  a  pul- 
monary complaint.  He  found  that  he  rather  retrograded  during 
the  winter,  but  always  gained  ground  during  the  summer.  "Could 
I  enjoy  for  a  few  years,"  he  observes,  "a  perpetual  Madeira  sum- 
mer, I  should  confidently  anticipate  the  most  beneficial  effects."  So 
high,  indeed,  is  his  opinion  of  the  summer  climate  of  Madeira,  that 
he  suggests  the  propriety  of  pulmonary  invalids,  who  can  con- 
veniently accomplish  such  a  plan,  passing  the  winter  in  the  West 
Indies,  and  the  summer  at  Madeira.  Of  the  effects  of  such  a  plan, 
however,  Dr.  Heineken  does  not  appear  to  have  had  any  experience. 

The  coolness  of  the  summer  at  Madeira  is  a  very  fortunate  cir- 
cumstance for  those  invalids  who  ought  to  pass  several  winters 


138         CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

abroad,  which  is  the  case  with  by  far  the  greater  number  of  con- 
sumptive patients;  and  for  whom  it  is  very  difficult  to  find  a  good 
situation  during  the  summer  on  the  Continent,  even  after  a  long 
and  often  tiresome  journey.  When  it  becomes  requisite  for  a  whole 
family  to  remove  to  a  mild  climate,  this  is  a  consideration  of  much 
weight,  more  especially  when  the  members  of  such  a  family  are 
chiefly  females.  In  Madeira,  the  invalid  has  only  to  change  his 
quarters  from  Funchal  to  a  more  elevated  situation  in  the  neigh- 
bourhood; or  go  to  the  north  side  of  the  island.  This  will  be  found 
a  still  more  favourable  summer  residence,  from  its  being  under  the 
influence  of  the  northeast  trade  wind,  which  blows  constantly  there 
during  the  summer  months,  and  affords  a  degree  of  coolness  and 
freshness  to  which  the  residents  on  the  south  side  of  the  island  are 
strangers.  There  is  now,  in  the  parish  of  St.  Ann's,  an  excellent 
house  established  for  the  accommodation  of  strangers,1  and  other 
houses  are  to  be  had.  Dr.  Renton  says,  "  that  from  his  personal 
knowledge  of  the  place,  as  well  as  from  the  accounts  of  those  who 
have  lived  there  during  the  three  warm  months  of  summer,  he  has 
no  hesitation  in  saying,  that  many  whom  he  formerly  recommended 
to  leave  the  island  on  the  approach  of  warm  weather,  and  who 
would  in  all  probability  be  obliged  to  return,  or  go  elsewhere,  the 
following  winter,  might  have  found  a  comfortable  residence  there, 
and  by  returning  to  Funchal,  or  its  neighbourhood,  at  the  proper 
season,  secured  the  enjoyment  of  a  wonderfully  equal  temperature 
during  the  whole  year."  The  invalid  may  thus  be  saved  a  voyage 
or  journey,  and  if  he  is  prudent,  he  will  often  find  that  he  has 
gained  more  in  health  during  the  summer  than  he  did  in  the  winter. 
"  As  a  permanent  abode,"  says  Dr.  Heineken,  in  a  written  commu- 
nication to  me,  "I  believe  Madeira  surpasses  every  other  place, 
because  it  contains  within  itself  the  means  of  equalising  the  annual 
temperature  more  completely  than  any  other  spot  with  which  we 
are  acquainted.  The  lowest  to  which  a  thermometer  exposed  all 
night  in  a  north  aspect  has  ever  fallen  in  Funchal  during  five 
years,  is  50°,  and  the  highest  to  which  it  will  ever  rise,  at  such  a 
distance  up  the  mountains  as  would  in  every  respect  suit  an  inva- 

1  This  house  is  described  by  Dr.  Macaulay,  ("  Notes  on  the  Physical 
Geography,  Geology  and  Climate  of  the  Island  of  Madeira,  in  the  Edinburgh 
New  Philosophical  Journal  for  October,  1840,")  as  situated  in  a  district  of 
great  beauty,  rich  in  plantations,  gardens,  and  vineyards.  Between  Funchal 
and  St.  Ann's  there  is  some  of  the  finest  scenery  of  the  island.  "Many 
artists,"  says  Dr.  Macaulay,  "  have  endeavoured  to  delineate  the  scenery  of 
Madeira;  but  by  far  the  most  successful  attempt  has  been  made  by  Mr. 
Picken,  a  young  artist  of  great  genius,  who  has  resided  for  several  winters 
on  the  island  on  account  of  his  health.  He  has  made  some  admirable  paint- 
ings of  the  principal  scenes,  including  the  city  of  Funchal.  To  the  geologist 
these  will  give  a  very  good  idea  of  the  appearances  and  physical  geography 
of  the  island,  and  will  be  generally  interesting  as  representations  of  the  most 
remarkable  natural  scenery  in  the  world." 

Mr.  Picken's  work  is  entitled,  "  Madeira  Illustrated ;"  and  is  published  by 
Day  and  Haghe,  Gate  Street,  Lincoln's-Inn-Fields,  London. 


ATLANTIC  CLIMATES.  139 

lid,  need  never  exceed  74°.  The  sirocco  visits  us  so  seldom,  and 
its  heat  may  so  readily  be  avoided  by  closing  the  doors  and  windows, 
that,  it  need  not  be  taken  into  account.  The  mean  annual  diurnal 
range  is  from  8°  to  10°;  but  an  invalid  may  with  ordinary  precau- 
tion, and  without  the  aid  of  fires,  live  in  a  temperature  never  vary- 
ing within  doors  more  than  perhaps  6°  throughout  the  twenty-four 
hours.  In  a  few  words,  I  would  say — there  is  no  occasion  for  a 
person,  throughout  the  winter  in  Funchal,  to  breathe,  night  or  day, 
within  doors,  an  atmosphere  below  the  temperature  of  64°;  or  in 
the  country,  and  at  such  a  height  as  to  ensure  dryness,  above  that 
of  74°;  that  he  may  during  the  summer  take  abundance  of  exercise 
by  choosing  his  hours  without  ever  exposing  himself  to  oppressive 
heats;  and  that  in  the  winter  he  need  not  be  confined  to  the  house 
the  whole  day  either  by  wet  or  cold  more  perhaps  than  a  score  of 
times." 

"I  am  acquainted  with  no  place,"  says  Captain  Basil  Hall,  "in 
which  such  a  variety  of  climates  may  be  commanded  with  certainty 
as  in  this  beautiful  island — beautiful  in  every  sense  ;  for  the  scenery 
is  so  varied,  that  almost  all  tastes  may  be  suited."1 

The  foregoing  evidence  is  quite  sufficient,  I  think,  to  show  that 
where  climate  is  likely  to  be  useful  in  consumption,  that  of  Madeira 
is  preferable  to  any  in  the  south  of  Europe  ;  and  Madeira  has  this 
important  advantage  over  all  other  places  frequented  by  invalids, 
as  I  have  just  remarked,  that  they  may  remain  there  during  the 
whole  year  without  suffering  from  oppressive  heat,  or  being  sub- 
jected to  the  inconvenience  of  a  long  journey.  When  such  con- 
sumptive patients  only  are  sent  abroad,  therefore,  as  ought  to  be 
sent,  a  proportion  of  them  may  pass  the  summer  safely,  and  often 
even  with  advantage  in  Madeira,  particularly  on  the  northern  side 
of  the  island.  But  perhaps  a  larger  proportion  would  suffer  from 
the  summer  heat  even  of  Madeira,  or  at  least  would  derive  benefit 
from  a  cooler  and  more  bracing  air.  The  latter  will  generally  be 
found  among  young,  growing  persons,  and  more  frequently  females 
of  relaxed  constitutions.  To  the  more  firm  and  rigid  frame  of  the 
adult,  in  whom  internal  congestion  is  much  more  to  be  dreaded 
than  relaxation,  the  summer  at  Madeira  will  often  prove  more 
beneficial  than  the  winter. 

But  how  proper  soever  it  may  be  for  an  invalid  who  has  passed 
the  winter  at  Madeira  to  remain  there  during  the  summer,  with  a 
view  of  spending  another  winter, — a  case  will  rarely  occur  in  which 
it  would  be  advisable  to  send  a  consumptive  patient  from  this  coun- 
try to  pass  the  summer  in  that  island.  An  invalid,  however,  who 
has  passed  the  winter  in  the  West  Indies,  probably  could  not  select 
a  better  situation  for  his  summer  residence  than  Madeira. 

Although  in  my  account  of  the  climate  of  Madeira  I  have  con- 
fined myself  to  its  influence  on  consumption,  there  can  be  no  doubt 

'Fragments  of  Voyages  and  Travels,  ^rs£  series. 


140         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

of  its  being  highly  beneficial  in  several  other  diseases  noticed  in 
this  work,  more  especially  scrofula  and  bronchial  affections. 

The  only  part  of  Madeira  where  invalids  reside  during  the  win- 
ter is  Funchal,  and  its  immediate  vicinity,  which  is  the  warmest 
part  of  the  island.  This  advantage  it  owes  to  its  being  open  only 
towards  the  south,  while  it  is  in  a  great  measure  screened  from  the 
north  by  the  central  mass  of  mountains  which  rise  immediately 
behind  it  in  the  form  *of  an  amphitheatre.  Invalids  peculiarly 
sensitive  to  humidity  should  live  within  the  limits  of  the  town,  on 
account  of  its  greater  dryness.  The  steepness  of  the  island  renders 
wheel  carriages  useless  ;  invalids  must  therefore  ride,  or  be  carried 
in  palanquins  or  hammocks.  There  is  abundance  of  horses,  sure 
footed,  and  accustomed  to  the  roads.  There  are  some  level  spots 
near  the  town,  where  invalids  may  take  exercise. 

The  soil  of  Madeira  is  dry,  consisting  mostly  of  the  debris  of 
volcanic  rocks.  Provisions  of  every  kind  are  good  and  abundant, 
and  the  water  is  pure  and  of  excellent  quality. 

Invalids  intending  to  pass  the  winter  in  Madeira,  should  leave 
this  country  in  October.  The  beginning  of  June  is  sufficiently 
early  to  leave  the  island  to  return  home,  as,  before  the  middle  or 
end  of  that  month,  the  weather  in  England  is  seldom  sufficiently 
warm,  or  at  least  steadily  so,  for  a  consumptive  patient  who  has 
passed  the  winter  in  a  mild  climate. 

Opportunities  of  going  from  this  country  to  Madeira  are  very 
frequent.  Independently  of  the  regular  traders  to  the  island,  many 
West  India  vessels,  and  the  monthly  packets  to  the  Brazils,  touch 
there  on  the  outward  voyage.  About  ten  days  may  be  considered 
the  average  time  of  making  the  passage ;  frequently  it  is  less,  and 
rarely  exceeds  fifteen  days.  The  opportunities  of  returning  from 
Madeira  are,  however,  by  no  means  so  frequent ;  as  comparatively 
few  vessels  touch  there  on  their  voyage  to  England.  Yet  I  believe 
that  in  this  respect  much  inconvenience  is  not  experienced.1 

CANARIES. 

The  Canaries  group  is  nearer  the  African  coast,  and  a  few 
degrees  further  south  than  Madeira,  from  which  they  are  about 
200  miles  distant. 

1  The  reader  who  is  desirous  of  obtaining  information  on  the  natural  his- 
tory, &c.  of  Madeira,  is  referred  to  the  writings  oi  Von  Buch  and  Gourlay,  to 
the  very  interesting  work  of  Professor  Daubeny  on  Extinct  Volcanoes, 
Wilde's  Narrative  of  a  Voyage  to  Madeira  and  the  Mediterranean,  1840, 
and  to  Dr.  Macaulay's  paper  already  referred  to. 

A  small  work,  Rambles  in  Madeira  and  Portugal,  contains  much  useful  in- 
formation, especially  in  the  Appendix,  on  the  Climate  &c.  of  Madeira,  written 
by  the  late  Dr.  Heineken.  There  has  been  recently  published  a  small  work, 
The  Invalid's  Guide  to  Madeira,  by  Mr.  Cooper,  which  may  be  consulted 
with  advantage.  Mr.  Picken's  beautiful  work,  already  referred  to,  also  con- 
tains much  useful  information  respecting  Madeira,  the  conveyances  to  and 
from  it,  &c. 


ATLANTIC  CLIMATES.  141 

Teneriffe  is  the  principal  island  and  the  only  one  of  the  group  pos- 
sessing accommodations  for  invalids.  Above  the  range  of  cultiva- 
tion, which  is  chiefly  confined  to  the  coast,  the  island  is  covered 
with  laurels,  arbutuses  and  pines,  whilst  the  uppermost  parts  are 
bare  and  sterile. 

Santa  Cruz,  the  capital,  is  situated  on  the  southeastern  shore  of 
the  island,  and  is  a  clean,  well-built  town.  The  country  around  is 
dry  and  barren. 

The  mean  annual  temperature  of  Santa  Cruz,  is  70°.9 ;  while 
that  of  Funchal,  the  capital  of  Madeira,  is  64°5.  This  excess  of 
temperature  at  Santa  Cruz,  is  not  equally  distributed  over  the  year  ; 
the  difference  between  the  summers,  at  the  two  places,  being  greater 
than  between  their  winters.  While  Santa  Cruz  is  7°  warmer  than 
Funchal  in  summer,  it  is  only  5°  warmer  in  winter.  The  tempera- 
ture is  more  equable  throughout  the  year  at  Madeira ;  the  difference 
between  the  mean  temperature  of  the  summer  and  winter  being 
9°.S.  and  at  Santa  Cruz,  12°.3.  The  heat  during  the  summer  is 
considerably  higher  in  the  Canaries  than  at  Madeira ;  although  it 
would  appear  that  in  this  respect  the  summer  temperature  of  Oro- 
tava, in  the  northern  part  of  the  island,  differs  little  from  that  of 
Funchal  and  its  vicinity. 

The  climate  of  Santa  Cruz  possesses  some  advantages  during 
winter,  in  point  of  temperature  and  dryness,  over  that  of  Funchal, 
but  there  are  no  accommodations  for  invalids.  There  are  a  few 
places  fit  for  carriage  or  horse  exercise,  particularly  the  terrace 
leading  from  Santa  Cruz  to  the  Lazaret,  which  is  about  a  mile 
long,  and  broad  enough  for  a  couple  of  carriages  to  drive  abreast. 
Mosquitoes  are  found  at  Santa  Cruz  during  the'whole  year. 

Orotava  is  a  town  on  the  northwestern  side  of  the  island,  twenty- 
five  miles  from  Santa  Cruz,  standing  at  the  foot  of  the  mountain, 
on  ground  gently  sloping  towards  the  sea-shore.  It  is  surrounded 
by  vineyards  and  cornfields.  The  country  immediately  behind  is 
described  as  very  beautiful,  arid  the  roads,  though  steep,  are  not  so 
precipitous  as  those  of  Madeira.  Orotava  is  cooler,  but  not  so  dry 
as  Santa  Cruz.  The  climate,  at  an  elevation  of  several  hundred 
feet  above  Orotava,  is  described  as  very  equable  during  the  whole 
year.  As  a  residence  for  invalids,  Orotava  possesses  many  advan- 
tages over  Santa  Cruz,  in  point  of  accommodations,  roads,  and 
beauty  of  country.  The  invalid  residing  at  Orotava  might,  by 
changing  his  residence  to  a  more  elevated  site,  remain  throughout 
the  summer,  without  suffering  much  inconvenience  from  the  heat, 
and  he  might  pass  the  winter  months  in  the  warmer  and  drier 
climate  of  Santa  Cruz. 

Laguna,  the  former  capital,  which  is  situated  at  some  elevation 
above  Santa  Cruz  is  cooler,  and  might  form  a  good  summer  resi- 
dence. 

Were  the  accommodations  for  strangers  at  Teneriffe,  and  the 
means  of  communication  between  it  and  Madeira  more  frequent, 


142 


CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 


many  invalids  might  benefit  greatly  by  passing  the  winter  partly  at 
Punchal  and  partly  at  Santa  Cruz. 

The  following  table  of  the  temperature  at  Orotava,  although  for 
one  year  only  (1834)  is  deserving  of  a  place  here,  in  the  absence  of 
more  extensive  data.  The  observations  were  made  with  a  register 
thermometer,  by  Mr.  Charles  Smith,  who  has  resided  several  years 
on  the  island. 


MONTHS. 

Mean 
Mini 

inun. 

Mean 
Maxi- 
mum. 

Mean 
Tem- 
perat. 

Mean 
Varia- 
tion. 

MONTHS 

Mean 
Mini- 
mum. 

Mean 
Maxi- 
mum. 

Mean 
Tem- 
perat. 

Mean 
Varia- 
tion. 

Jan. 
Feb. 
March, 
April, 
May, 
June, 
July, 
Aug. 

55 
56 
59 
60 
63 
65 
66 
67 

68 
65 
69 
71 
75 
77 
78 
78 

6H 
60i 
64 
65i 
69 
71 
72 
72£ 

13 

9 
10 

11 

12 
12 
12 
11 

Sept. 
Oct. 
Nor. 
Dec. 

66 

65 
62 
60 

77 
77 
74 
71 

71i 
71 
68 
65i 

11 
12 

12 

11 

Means  for 
the  Year. 

62 

73* 

67 

111 

AZORES. 

The  Azores,  or  Western  Islands,  lie  in  the  midst  of  the  Atlantic 
Ocean,  about  five  degrees  further  north,  and  considerably  more  to 
the  westward  than  Madeira.  Of  volcanic  origin,  they  rise  abruptly 
out  of  the  water,  and  present  numerous  mountains,  covered  to  the 
very  top  with  perpetual  verdure.  The  conical  mountain,  which 
gives  name  to  the  island  of  Pico,  and  which  is  about  8000  feet 
high,  has  its  summit  often  covered  with  snow  during  the  winter 
and  spring. 

St.  Michael's  is  the  largest  of  the  Azores,  and,  with  the  exception 
of  the  little  island  of  St.  Mary's,  the  southernmost  of  the  group.  It 
is  of  an  irregular  oblong  form,  and  extends  from  west  to  east  rather 
more  than  forty-eight  miles ;  its  greatest  breadth  is  eleven  and  its 
least  six  miles.  The  extremities  of  St.  Michael's  are  mountainous; 
the  eastern  end  the  most  so ;  the  highest  points  rise  three  or  four 
thousand  feet  above  the  level  of  the  sea ;  the  intermediate  part  is 
hilly.  The  soil  consists  of  pumice,  volcanic  clay,  and  other  decom- 
posed volcanic  products,  lying  upon  horizontal  strata  of  basaltic 
lava. 

The  chief  town  of  the  island  is  Ponta  Delgada,  containing  up- 
wards of  twelve  thousand  inhabitants.  The  surrounding  country 
is  for  many  miles  tolerably  level,  and  the  roads  fit  for  carriages. 
Asses,  for  riding  and  carrying  burdens,  may  be  hired  for  a  small 
sum.  Horses  and  carriages  are  kept  by  private  individuals. 

Consuls  for  Britain  and  America,  and  many  English  and  Ameri- 
can merchants,  reside  at  Delgada,  and  there  is  a  Protestant  episco- 
pal chapel  and  chaplain.  Furnished  lodgings  are  not  to  be  had,  but 
houses  may  be  rented  at  a  moderate  sum :  there  are  two  boarding 
houses. 


ATLANTIC  CLIMATES.  143 

Villa  Franca,  another  town  on  the  southern  coast  of  St.  Michael's, 
twelve  or  fifteen  miles  to  the  eastward  of  Delgada,  is  more  pleasantly 
situated,  being  protected  behind  from  the  northeast  winds  by  a  range 
of  mountains.  It  has  a  sandy  beach,  and  its  neighbourhood  is  not 
so  much  obstructed  by  the  high  walls  of  orange  gardens  as  that  of 
Delgada.  It  contains  about  four  thousand  inhabitants,  but  there 
are  no  English  residents.  The  soil  is  a  light  porous  pumice,  of 
from  ten  to  fifty  feet  in  depth,  covering  the  horizontal  strata  of  lava. 
The  heaviest  rains  are  speedily  absorbed,  so  that  the  roads  are  left 
dry.  The  water  which  filters  through  this  pumice  soil  is  very  pure 
and  abundant. 

There  are  no  express  accommodations  for  invalids,  but  houses 
rnay  occasionally  be  hired. 

The  mean  in-door  temperature  of  a  room  without  fire,  carpet,  or 
curtains,  in  Villa  Franca,  during  the  period  from  December  1838  to 
April  1839,  was  60°.9,  with  a  mean  range  of  3°.6.  The  mean  out- 
door temperature,  during  the  same  time,  was  60°.10,  and  the  mean 
daily  range  7°.6.  The  highest  point  to  which  the  thermometer  rose 
in  the  shade,  between  eight  o'clock  in  the  morning  and  ten  at  night, 
was  76°,  and  the  lowest  point  to  which  it  sank  was  51°.  Thus,  the 
mean  temperature  during  the  winter  is  about  2°  colder  than  Madeira. 
It  is  to  be  remarked  that  the  averages  out-of-doors  were  not  taken 
with  the  register  thermometer;  they,  however,  approximate  the 
truth,  and  prove,  what  is  evident  to  the  feelings  of  the  visiter,  that 
the  temperature  is  remarkably  steady,  ranging  little  from  day  to 
day,  and  varying  little  between  day  and  night.  Dr.  Bullar  remarks, 
"that  to  his  feelings  it  was  always  warmer  out  of  doors." 

The  monthly  average  of  days  on  which  rain  fell  in  Villa  Franca, 
during  the  period  above  specified,  was  ten.  This  estimate,  how- 
ever, affords  little  direct  information  as  to  the  humidity  of  the 
climate.  The  rain  on  some  days  was  nothing  more  than  a  moun- 
tain scud,  of  a  few  minutes  duration ;  and,  at  other  times,  it  fell  for 
several  hours ;  but,  during  the  whole  five  months,  there  was  not  a 
day  in  which  many  hours  were  not  available  for  exercise  in  the 
open  air.  At  the  same  time,  the  humidity  of  the  atmosphere  is  so 
great,  that  boots  grow  mouldy  in  a  few  days,  kid  gloves  become 
spotted,  books  feel  damp,  and  clothes,  not  constantly  worn,  have  a 
musty  smell.  To  prevent  these  inconveniences,  the  inhabitants 
frequently  expose  their  clothes  to  the  sunshine.  Salt  fish  soon 
spoils,  so  that  no  quantity  is  ever  kept,  and  no  salt  is  made  in  the 
islands. 

The  prevalent  winds  were  in  December  northeasterly;  in  January, 
February,  March  and  April,  southerly.  The  southerly  and  west- 
erly winds  are  soft  and  warm.  The  northeasterly  are  cold,  but  not 
keen.  The  sirocco  is  never  felt  at  the  Azores.  Gales  arid  stormy 
winds  blow  from  the  southward  and  westward,  and  are  not  unfre- 
quent. 


144         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 


Register  Thermometer 
within  doors. 

Thermometer  in  the  open  air  at 
four  hours  of  the  day. 

a 
'« 

5-1 

P  g 

fl-3 

H 

to 

..-J     OQ 

'5  c 

Ok 

Max. 

Min. 

Med. 

Ran. 

A.  M. 

8 

P.  M. 
1 

P.M. 

6 

P.   M. 
10 

Med. 

£»>    . 

56 

•0  (= 

&<* 

! 

Dec. 
Jan. 
Feb. 
Marph 
April 

Mean 

60 
63 
63 
64 
63 

62.6 

57 
60 
60 
60 
59 

59.2 

58.5 
61.5 
61.5 
62 
61 

60.9 

4 
3 
3 

4 

4 

3.6 

55 
60 
63 
61 
62 

63 
64 
66 
66 
66 

52 

58 
60 
61 
59 

58 
58 
58 
60 
56 

57 
60 
61.25 
62 
6055 

5 

9 
8 
6 
10 

17 
13 
10 
14 

25i 
2H 

10 
10* 

1* 

2 

N.E. 
S.  E. 
S.W. 

s.w. 

S.E. 

60.2 

65 

58 

58 

60.18 

7.6    10.8 

19.25 

The  islands  of  Terceira  and  Fayal,  next  in  importance  to  St. 
Michael's,  are  about  160  miles  to  the  northwest  of  that  island,  in 
the  centre  of  the  group,  together  with  three  others,  Pico,  St.  George, 
and  Graciosa.  From  what  he  heard,  Dr.  Bullar  thinks  Fayal 
damper  than  St.  Michael's. 

The  principal  town  of  Fayal  is  Horta,  pleasantly  situated  on  the 
east  side  of  the  island,  on  rising  ground  sloping  down  to  the  margin 
of  a  fine  bay.  It  contains  several  thousand  inhabitants,  many 
Americans  and  their  consul,  besides  an  English  consul  and  physi- 
cian. There  is  a  boarding  house,  and  houses  may  be  rented.  The 
country  around  affords  a  considerable  variety  of  pleasant  walks 
and  rides. 

There  is  constant  communication  between  the  Azores  and  Eng- 
land, during  the  winter,  when  the  oranges  are  exported.  The 
communications  between  the  different  islands  is  frequent  after 
March,  but  uncertain  during  winter. 

In  all  the  islands,  poultry,  eggs,  and  fish  are  abundant  and  cheap. 
In  the  chief  towns,  beef  and  mutton  can  be  procured,  as  well  as 
milk  and  butter.  The  bread  is  light  and  good.  The  wines  indif- 
ferent, but  unadulterated. 

Water  at  St.  Michael's  is  good  and  abundant.  The  soil  when 
cultivated,  is  rich  and  productive.  The  whole  of  the  islands  abound 
in  fine  scenery,  but  there  is  a  deficiency  of  trees,  though  not  of 
vegetation. 

The  climate  of  this  group  of  small  islands,  situated  in  the  centre 
of  the  Northern  Atlantic,  nearly  equidistant  from  the  poles  and  the 
equator,  and  surrounded  on  all  sides  by  a  vast  extent  of  ocean,  is 
purely  oceanic,  and  affords  one  of  the  best  examples  of  a  mild, 
humid,  equable  climate  to  be  met  with  in  the  northern  hemisphere. 
It  is  slightly  colder  and  more  humid  than  Madeira,  but  probably 
even  more  equable. 

In  diseases  in  which  a  soft,  soothing  climate  is  indicated,  that  of 
the  Azores  will  prove  beneficial ;  in  gastritic,  or  inflammatory  dys- 
pepsia, and  in  bronchial  irritation,  accompanied  with  little  secre- 
tion. On  the  other  hand,  in  a  relaxed  state  of  the  system — in  those 
morbid  conditions  of  the  mucous  membranes,  attended  with  copious 


ATLANTIC  CLIMATES.  145 

discharges — and  in  an   enfeebled  state  of  the  digestive  organs, 
(atonic  dyspepsia,)  it  will  decidedly  disagree. 

There  are  many  cases  of  a  mixed  character,  where  irritation  of 
the  mucous  surfaces  co-exists  with  a  relaxed  state  of  system.  In 
such  the  climate  may  prove  beneficial  for  a  time,  but  as  soon  as  the 
state  of  irritation  is  abated,  its  relaxing  effects  will  prove  injurious. 
A  removal  to  a  drier  and  more  bracing  climate  would  then  be 
desirable  and  even  necessary. 

The  most  prevalent  disease  among  the  natives  is  gastrodynia,  or 
a  painful  affection  of  the  stomach  ;  a  dull,  continuous  pain,  lasting 
many  hours.  This  is  not  surprising  when  the  principal  food  of 
the  poor  (whose  diseases  were  those  which  chiefly  fell  under  the 
observation  of  Dr.  Bullar)  consists  of  cabbage  and  potatoes  chopped 
up  with  a  little  lard.  Painful  affections  of  other  parts  are  next  in 
frequency;  rheumatic  neuralgia,  lumbago,  sciatica,  neuralgic  pains 
of  the  face,  neck,  and  arms,  hemicrania  and  loss  of  power,  partial 
paralysis.  Of  acute  diseases,  bronchitis  was  the  most  frequent ; 
asthma  also  prevailed ;  phthisis  is  very  rare.1 

Comparing  Madeira,  the  Canaries,  and  the  Azores,  it  will  be 
observed  that;  although  in  some  circumstances  they  are  alike,  they 
are  very  dissimilar  in  others.  They  have  the  same  form  and 
geological  structure,  being  all  mountainous  and  of  volcanic  origin, 
but  differ  materially  in  their  vegetable  productions,  and  in  the  cha- 
racter of  their  climate,  both  as  regards  humidity  and  temperature. 
There  is  a  gradual  transition  from  the  humid,  soft,  equable  climate 
of  the  Azores,  of  which  the  mountains  are  covered  to  the  very 
summit  with  evergreens,  to  the  arid,  rocky  soil  of  Teneriffe  where 
the  want  of  rain  during  the  greater  part  of  the  year  renders  much 
of  the  island  dry  and  sterile.  Madeira,  situated  considerably  more 
to  the  south  than  the  Azores,  and  more  distant  from  the  African 
coast  than  the  Canaries,  presents  an  intermediate  climate  in  com- 
parison with  these  two  groups.  Less  humid  than  the  Azores,  and 
less  dry  than  Teneriffe  during  the  winter,  it  has  the  advantage  of 
a  cooler  summer  than  either.  This  it  owes  chiefly  to  its  being 
within  the  limits  of  the  trade  winds  during  the  hot  season. 

A  change  from  the  Azores  to  Madeira,  and  from  thence  to  Tene- 
riffe, would,  in  many  cases,  prove  more  beneficial  than  a  residence 
during  the  whole  winter  in  any  one  of  these  islands. 

1  For  the  above  account  of  the  Azores,  I  am  indebted  to  my  friend  Dr. 
Bullar,  who  passed  the  winter  and  spring  of  1839-40  there ;  and  who,  in 
conjunction  with  his  brother,  has  just  published  an  interesting  work  descrip- 
tive of  these  islands,  entitled,  "  A  Winter  in  the  Azores." 


— c  10  dark 


146 


CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 


WESTERN    ATLANTIC. 
;v  ,,  BERMUDAS. 

The  Bermudas  consist  of  a  cluster  of  small,  low  islands.  The 
largest  is  only  twelve  miles  long,  and  about  three  broad ;  and  the 
whole  extent  of  the  group,  from  one  extremity  to  the  other,  is  not 
more  than  twenty  miles.  The  highest  point  of  land  in  any  of  the 
islands  does  not  exceed  200  feet  above  the  sea  level.  They  are 
composed  chiefly  of  a  coarse,  shelly  sand-stone  of  an  extremely 
porous  quality,  and  so  soft  as  to  be  cut  easily  with  the  saw  and 
adze  into  the  various  forms  necessary  for  building,  &c.  From  the 
absorbing  nature  of  the  Bermuda  rack,  the  soil,  which  is  naturally 
thin,  is  extremely  arid.  There  are  no  springs,  the  inhabitants  being 
almost  entirely  dependent  upon  rain  water,  which  is  collected  on 
the  roofs  of  the  houses,  and  by  other  artificial  means,  and  preserved 
in  stone  cisterns,  called  tanks.  The  water  is  generally  good,  but 
the  supply  is  occasionally  deficient  in  very  dry  seasons.  Although 
the  Bermuda  islands  are  low,  they  are  by  no  means  flat,  the  surface 
being  of  an  undulating  and  even  hilly  character.  The  high  grounds 
are  mostly  covered  with  cedar  trees,  which,  while  they  form  a  pecu- 
liar feature,  are  the  most  beautiful  ornament  of  these  islands,  and, 
at  the  same  time,  their  most  valuable  production.  But  there  can  be 
no  doubt  that  Bermuda  might  be  made  much  more  productive  by 
proper  cultivation ;  as  has  indeed  been  proved  during  the  non- 
intercourse  with  America.  It  is,  however,  in  general,  supplied 
with  provisions  from  the  United  States  and  our  North  American 
colonies. 

TABLE  of  the  Range  of  the  Thermometer  at  St.  George's  on  an  Average  of 

Five  Years :— 


MONTHS. 

THERMOMETER. 

DIURNAL  RANGE. 

January  .... 
February    .  .  . 
March  

Max. 
deg. 
72 

71 
72 
71 
75 

86 
89 
89i 
87 
86* 
82 
76 

Med.      , 
deg. 

65| 
641 
65 
64| 
70 
79 
83^ 
83 
82| 
76i 
76i 
69£ 

Min. 
deg. 
55 

53 
54 
56i 
57 
68 
75 
75 
74 
65 
64 
56 

Greatest. 

r 

10 

9f 

10 
11 
10 
12 

12 
9 
10 

7 
8 

Mean, 
deg. 
4 

51 

4* 
5* 
61 

7 
71 

8 
6 

4* 

4 
4i 

Least, 
deg. 

li 

l 

ii 
ii 

2 
3 
2 
1 
4 
1 
0| 

o* 

June  ...     .. 

July    . 

August.  .  . 
September 
October  .  . 
November  . 
December  . 

Mean    

79f 

73i 

63 

9i 

51 

11 

From  the  small  size  and  little  elevation  of  the  Bermudas,  they 
are  fully  exposed  to  winds  from  every  quarter,  and  are  under  the 


ATLANTIC  CLIMATES.  147 

immediate  influence  of  all  the  changes  which  occur  in  the  atmo- 
sphere of  the  surrounding  ocean;  which,  as  we  have  already 
remarked,  is  more  liable  to  great  and  rapid  changes  of  temperature, 
and  more  subject  to  storms  than  the  Eastern  Atlantic. 

Bermuda  may  be  considered  upon  the  whole  a  healthy  place. 
There  are  no  endemic  diseases;  although  occasionally,  during  the 
autumn,  fevers  of  a  character  resembling  those  which  form  the 
scourge  of  the  West  Indies,  prevail  with  considerable  violence ;  but 
this  is  by  no  means  an  annual  occurrence.  Bowel  complaints  are 
the  most  common  diseases.  Consumption  is  also  frequently  ob- 
served among  the  inhabitants;  and  it  appears  from  the  Army 
Reports  that  inflammation  of  the  lungs  and  consumption  are  very 
prevalent  among  the  troops  stationed  there.  The  ratio  of  mortality 
from  consumption  being  nearly  nine  per  thousand  of  the  strength 
annually,  which  is  more  than  among  the  troops  in  the  United  King- 
dom, or  in  any  of  the  Mediterranean  stations. 

The  cool  season,  that  is,  from  October  till  May,  is  the  most 
healthy,  and  the  only  part  of  the  year  during  which  this  climate  is 
at  all  suited  to  invalids.  One  of  the  principal  objections  to  Ber- 
muda, as  a  winter  residence  for  pulmonary  invalids,  is  the  preva- 
lence of  strong  winds  ;  which  are  such  as  to  justify  the  epithet  ap- 
plied by  Shakespeare  to  these  islands,  "the  still-vexed  Bermoothes." 
Of  these  winds  the  damp,  oppressive  southwest  is  the  prevailing ; 
but  the  most  violent  and  injurious  to  delicate  invalids  during  the 
winter  and  spring,  are  the  northwest  winds  which  are  generally 
dry,  sharp,  and  cold.  Compared,  however,  with  the  climate  of  the 
coast  of  America,  under  the  same  latitude,  Bermuda  may  be  said  to 
have  no  winter.  The  summer  is  very  hot;  being  generally  admit- 
ted, I  believe,  by  those  who  have  experienced  both  climates,  to  be 
more  oppressive  than  the  same  season  in  the  West  Indies.  This 
may  be  accounted  for,  partly  from  the  want  of  the  trade  winds,  and 
partly  from  the  bare,  arid  nature  of  the  soil,  which  becomes  quite 
parched  during  the  summer.  Vegetation  almost  disappears  at  this 
season  ;  the  cedar  and  wild  sage  alone  resisting  the  heat.  Dew  is 
occasionally  deposited  in  winter,  when  a  cold  night  succeeds  a  hot 
day,  but  never  in  the  summer.  The  principal  falFof  rain  is  between 
August  and  October ;  there  are  also  very  heavy  showers  in  January 
and  February,  but  seldom  any  during  the  summer  months. 

Prom  what  has  been  stated,  a  tolerably  accurate  opinion  may  be 
formed  respecting  the  general  qualities  of  the  climate.  It  is  variable 
and  windy  during  the  winter,  and  hot  and  oppressive  in  the  sum- 
mer. Compared  with  Madeira,  which  lies  in  the  same  parallel  of 
latitude,  the  climate  will  be  found  much  more  unequal.  The  tem- 
perature of  the  two  places  during  the  winter  may  be  much  the 
same ;  but  there  is  a  wide  difference  in  that  of  summer.  The  cool- 
ness of  this  season  at  Madeira  forms  a  striking  contrast  with  the 
oppressive  heat  of  Bermuda. 

With  so  few  advantages  in  point  of  climate,  the  Bermudas  are  not 
likely  to  become  the  resort  of  invalids  from  this  country.  Their 

10* 


148         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

great  distance,  the  infrequency  of  communication  with  England, 
and  the  defective  accommodations  for  strangers,  form  additional 
objections.  Provided,  however,  that  domestic  circumstances  ren- 
dered Bermuda  a  convenient  residence,  invalids  might  pass  the 
winter  there  safely,  and  perhaps  with  benefit.  There  are  many 
beautiful  spots  in  these  islands,  where,  protected  from  the  northerly 
gales  by  the  cedar-clothed  hills,  the  invalid  might  find  sufficient 
space  to  enjoy  exercise  in  the  open  air,  almost  every  day  during 
the  winter.  The  neighbourhood  of  the  little  town  of  Hamilton, 
situated  nearly  in  the  centre  of  the  islands,  affords  perhaps  the  most 
favourable  situation  for  such  a  residence. 


BAHAMAS. 

Were  we  to  consider  the  latitude  only  of  these  islands,  they  might 
almost  be  classed  with  the  West  Indies,  as  they  are  on  the  very 
limits  of  the  tropics ;  but  their  vicinity  to  the  American  continent 
so  modifies  their  climate,  as  to  give  it  a  different  character  from 
that  of  the  intertropical  islands.  The  Bahama  islands  form  a  very 
numerous  group,  of  which  about  twelve  are  of  considerable  size. 
They  are  all  low,  and  chiefly  of  coralline  formation.  They  con- 
tain no  natural  springs,  water  being  procured  only  by  digging  deep 
wells ;  and,  in  many  places,  the  water  thus  obtained  is  not  good. 

The  easterly,  or  trade  wind,  although  the  prevailing  wind,  is 
much  less  regular  here  than  in  the  same  latitude  on  the  eastern  side 
of  the  Atlantic.  Southerly  winds,  which  are  hot  and  oppressive, 
often  occur,  and  are  generally  accompanied  with  a  heavy  deposi- 
tion of  dew  during  the  night.  The  northwest  wind  frequently 
prevails ;  and  as  this  wind  blows  with  very  considerable  force,  it 
produces  a  rapid  fall  of  temperature,  more  especially  when  it  im- 
mediately follows  a  southerly  wind. 

The  following  table  shows  the  monthly  range  of  the  thermometer 
at  Nassau,  on  an  average  of  five  years, — 1830  to  1834  inclusive : — 


Months. 

Jan. 

Feb. 

Mar. 

Apr. 

May 

Jun. 

July 

Aug. 

Sep. 

Oct. 

Nov 

Dec. 

Max.. 

77$ 

76 

80$ 

83 

86$ 

89 

92 

90 

89 

83$ 

79 

76$ 

Med.  . 

71 

73 

75 

79 

81$ 

84$ 

86 

86* 

85 

79 

73 

70 

Min.  . 

66 

69$ 

69 

75$ 

77 

80 

83 

83 

81 

73$ 

67 

63  1 

Average,— Max.  83$,  Med.  78$,  Min.  74. 

From  May  to  November  the  range  of  the  thermometer  is  from 
75°  to  85°,  seldom  rising  above  90°.  This  increase  of  temperature 
is  generally  accompanied  by  southerly  winds  or  calms,  which  are 
described  as  being  very  oppressive. 

According  to  these  tables,  the  mean  annual  temperature  is  78$° ; 
and  the  range  28i° ;  viz.,  from  63£°  to  92°.  In  the  West  Indies, 


ATLANTIC  CLIMATES.  149 

the  former  is  80°,  the  latter  20°.  The  temperature  of  the  seasons  is 
as  follows :  winter  71°,  spring  77°,  summer  83°,  autumn  80°.  At 
Barbadoes,  the  winter  is  76°.7,  spring  79°,  summer  81°,  autumn  80°. 
From  this  comparison  it  appears,  that  while  the  winter  is  nearly  6°, 
and  the  spring  2°  colder,  the  summer  is  2°  warmer  than  at  Barba- 
does :  the  autumn  temperature  at  both  places  being  the  same.  The 
explanation  of  the  high  temperature  of  the  Bahamas,  during  the 
two  latter  seasons,  is  probably  to  be  found  in  the  frequent  occur- 
rence of  southerly  winds  during  that  period  of  the  year,  and  in  the 
less  degree  of  regularity  of  the  trade  winds  at  these  islands  than 
within  the  tropics.  In  the  winter  and  spring,  however,  the  tempe- 
rature is  considerably  lower,  and  this  is  the  period  of  the  year 
which  chiefly  interests  us  in  our  present  inquiry. 

At  New  Providence,  the  weather,  during  the  cold  season,  which 
extends  from  November  to  May,  is  generally  fine,  clear,  and  dry; 
the  thermometer  in  the  shade  being  generally  from  60°  to  70°,  the 
mid-day  heat  tempered  by  a  constant  breeze,  and  the  evenings  cool 
and  agreeable. 

The  Bahama  islands,  generally  speaking,  are  not  unhealthy ; 
although  there  is  a  considerable  difference  in  this  respect  between 
the  different  islands.  That  of  New  Providence,  in  which  is  the 
capital,  Nassau,  the  only  town  in  the  colony,  is  not  by  any  means 
one  of  the  healthiest,  on  account  chiefly  of  some  swampy  ground 
which  it.  contains.  The  small  island,  called  Harbour  Island,  close 
to  Eleuthera,  one  of  the  largest  of  the  group,  is  esteemed  particu- 
larly healthy,  and  forms  the  chief  resort  of  invalids  and  convales- 
cents from  New  Providence.  There  are  several  other  healthy  spots, 
as  on  the  island  of  Abaco ;  but  at  all  these  places  there  is  a  great 
deficiency  of  accommodations,  and  moreover,  they  are  sixty  miles 
distant  from  Nassau,  the  only  place  where  medical  advice  is  to  be 
found. 

The  most  prevalent  diseases,  are  fevers,  chiefly  of  the  intermit- 
tent and  remittent  character,  and  bowel  complaints ;  cholera  is  not 
uncommon,  and  occasionally  the  Bahamas  are  visited  by  epidemics 
of  yellow  fever ;  but  the  two  first  mentioned  diseases  are  by  far  the 
most  prevalent. 

From  the  above  description,  it  appears  evident  that  the  Bahama 
islands  are  not  well  calculated  for  the  generality  of  invalids.  The 
climate  is  not  suited  for  consumptive  patients,  on  account  of  the 
rapid  changes  of  temperature,  and  the  prevalence  of  winds,  often  of 
a  dry,  cold  character.  At  the  same  time  persons,  for  whose  cases  a 
warm  climate  is  indicated,  may  pass  the  winter  in  the  Bahamas 
safely;  and  residents  in  the  West  Indies  might  derive  considerable 
benefit  by  a  change  to  these  islands  for  a  few  months  during  this 
season.  The  wet  and  dry  seasons  occur  pretty  regularly  at  the 
same  periods  of  the  year,  as  within  the  tropics.  The  same  rules 
which  are  laid  down,  in  the  article  on  The  West  Indies,  respecting 
the  arrival  and  departure  of  invalids,  and  the  conduct  to  be  observed 


150         CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

during  their  residence,  are  generally  applicable  to  those  visiting  the 
Bahamas. 

THE  WEST  INDIES. 

I  consider  it  necessary  to  notice  the  West  India  Islands,  because 
they  are  occasionally  recommended  as  a  winter  residence  to  patients 
labouring  under  pulmonary  and  some  other  chronic  diseases  ;  and 
because  their  climate,  either  as  regards  its  physical  characters  or  its 
influence  on  disease,  does  not  seem  to  be  generally  known  or  under- 
stood by  medical  men  in  this  country. 

The  mean  annual  temperature  of  the  West  India  Islands  near 
the  sea,  is  about  79°  or  80°;  the  mean  daily  range  about  6°  only ; 
and  the  extreme  annual  range  not  more  than  20°.  The  mean  tem- 
perature of  the  sea  at  considerable  depths  in  the  vicinity  of  these 
islands  is  80° ;  and  this  is  also  the  temperature  of  the  springs  near 
the  level  of  the  sea  in  Jamaica,  as  noticed  by  Dr.  Hunter.1  The 
mean  temperature  of  the  seasons,  according  to  the  European  divi- 
sion adopted  in  this  work,  is  at  Barbadoes  as  follows — winter,  76°  7  ; 
spring,  79°;  summer,  81°;  autumn,  80°. 

The  above  applies  to  the  whole  of  these  islands  near  the  level  of 
the  sea ;  the  difference  in  different  islands  being  scarcely  worth 
remarking.  The  mean  temperature  of  Barbadoes,  according  to 
Hillary,  is  79°  3 ;  the  greatest  range  in  six  years  being  17°,  viz. 
from  70°  to  87° ;  and  Dr.  Thomas  makes  this  18°,  viz.  from  70°  to 
88°.  Sir  Gilbert  Blane  once  found  the  thermometer  in  this  island 
at  sun-rise,  in  December,  at  69°.2  Dr,  Hunter  observed  it  once 
only  at  the  same  degree  ;  and  twice  only  as  high  as  91°  in  Jamaica.3 
The  greatest  range  which  I  find  noticed  by  any  author  at  the  sea 
level  is  22°,  viz.  from  70°  to  92.°  Dr.  Fergusson  says,  the  mean 
daily  range  in  summer  is  from  80°  to  86°,  and  in  winter  from  70°  to 
80°.  The  mean  temperature  of  Grenada,  at  noon,  according  to  Dr. 
Chisholm,  is  84°,  and  at  seven  A.  M.  78°  5.  This  gentleman  gives 
the  following,  as  the  diurnal  progression  of  temperature: — "The 
thermometer  (Fahrenheit's)  almost  universally  exhibits  the  follow- 
ing movements.  At  seven  A.  M.  the  mercury  begins  to  rise,  and 
continues  to  do  so  till  one  p.  M.,  from  which  time  till  four  p.  M.  it  is 
stationary.  It  then  begins  to  fall,  and  continues  to  do  so  till  ten 
p.  M.,  from  which  time  till  seven  A.  M.  it  is  again  stationary.  This 
routine  of  temperature  is  disturbed  only  when  any  remarkable 
change  takes  place  in  the  atmosphere,  such  as  much  rain  attended 
with  strong,  wind  :  the  greatest  change  from  this  cause  I  have 
observed  is  10°,  the  least  4°.  The  thermometer,  exposed  to  the 
direct  rays  of  the  sun,  has  risen  in  ten  minutes  to  130°,  or  42°  above 
its  stationary  point  at  one  p.  M.  of  that  day;  30°  may,  however,  be 
considered  the  medium  difference  between  the  heat  in  the  shade 


1  Observations  on  Diseases  of  the  Army  in  Jamaica. 
*  Diseases  of  Seamen.  z  Op.  citat. 


ATLANTIC  CLIMATES.  151 

and  in  the  sun.1  The  medium  difference  between  the  heat  of  the 
atmosphere  at  one  and  ten  P.  M.  is  9°."2  At  Jamaica,  Dr.  Arnold 
always  observed  the  mercury  begin  to  rise  about  10  or  15  minutes 
before  the  sun  emerged  from  the  horizon.  Its  ascent  was  gradual 
until  it  reached  its  maximum,  which  generally  happened  between 
two  and  four  p.  M.  He  tried  many  thermometers  for  the  purpose 
of  ascertaining  the  extreme  solar  heat,  and  often  observed  the 
mercury  rise  to  130°  Fahr.  in  the  month  of  September. 

The  winter,  and  early  part  of  the  spring,  are  in  general  remark- 
ably dry,  and  the  weather  fine;  the  wind  being  more  northerly 
than  usual.  The  summer  is  dry  and  hot ;  and  autumn  the  season 
of  the  heavy  rains ;  but  there  is  seen  little  of  that  continuous  rain 
which  occurs  in  temperate  climates.  The  annual  fall  of  rain  is 
probably  about  65  inches;3  but  in  the  quantity  of  rain  which  falls 
in  the  different  islands  there  is  a,  much  greater  difference  than  in 
their  temperature.  In  the  mountainous  islands,  generally,  the  fall 
much  exceeds  that  in  the  low  islands.  At  Martinique,  for  example, 
the  fall  is  said  to  amount  to  100  inches  ;  while  at  Barbadoes.  accord- 
ing to  Hillary,  it  is  58 ;  and  at  Antigua  only  45  inches.  The  greatest 
fall  of  rain  takes  place  in  October.  In  November  the  weather  gene- 
rally begins  to  clear  up,  the  northeasterly  winds  resume  their  regu- 
larity; and  from  the  beginning  of  December  till  the  vernal  rains  of 
April  and  May,  the  weather  is  dry,  settled,  and  comparatively  cool. 

From  the  rapid  manner  in  which  the  rain  descends  within  the 
tropics,  a  large  proportion  of  it  is  carried  off  in  torrents,  and  it  must 
be  remembered  that  the  evaporation  is  extremely  rapid.  At  Antigua 
it  amounted,  in  1818,  to  28-26  inches,  the  fall  being  65.  The 
evaporation  in  the  different  seasons  was  as  follows: — Winter,  6-26; 
spring,  6-99  ;  summer,  8-09  ;  autumn,  7-06;  leaving  unevaporated — 

1  This  great  increase  of  temperature  is  not  produced  by  the  direct  power 
of  the  sun's  rays,  but  is  caused  chiefly  by  the  concentration  and  reflection 
of  heat  from  the  surface  of  the  earth.     If  the  influence  of  reflected  heat  be 
avoided,  the  difference  between  the  sun  and  the  shade  amounts,  in  the  West 
Indies,  to  a  few  degrees  only.     Baron  de  Hurnboldt  often  endeavoured  to 
measure  the  power  of  the  sun  between  the  tropics  by  two  thermometers  of 
mercury  perfectly  equal,  one  of  which  remained  exposed  to  the  sun,  while 
the  other  was  placed  in  the  shade.     The  difference  resulting  from  the  ab- 
sorption of  the  rays  in  the  ball  of  the  instrument  never  exceeded  6°  6  Fahr. ; 
sometimes  it  did  not  even  rise  higher  than  one  or  two  degrees.  Mr.  Daniell's 
observations   go   far  to   show    "  that  the  power  of  solar  radiation  in  the 
atmosphere  increases  from  the  equator  to  the  poles,  and  from  below  up- 
wards."— Meteorological  Essays  and  Observations. 

The  temperature  in  the  shade  often  rises  higher  in  northern  latitudes  than 
in  the  West  Indies.  It  is  the  duration  of  heat  much  more  than  its  intensity, 
as  Humboldt  justly  remarks,  which  characterises  the  climate  of  the  tropics. 
And  I  may  add,  that  it  is  this  unceasing  heat  which  is  one  of  the  principal 
causes  of  the  injurious  influence  of  tropical  climates  on  European  constitu- 
tions. 

2  Manual  of  the  Climate  and  Diseases  of  Tropical  Countries,   &c.,  by- 
Colin  Chisholm,  M.  D. 

3  Edwards  gives  from  60  to  65  inches  as  the  average  fall  throughout  the 
whole  islands.— History  of  West  Indies,  vol.  i.  p.  12. 


152        CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

winter,  5-41 ;  spring,  6-22;  summer,  6-39;  autumn,  19-53.  I  am 
not  aware  of  any  series  of  hygrometrical  observations  having  been 
made  in  the  West  Indies.1  In  the  lower  islands  little  dew  is  depo- 
sited ;  but  in  the  higher  islands,  where  the  range  of  temperature  is 
greater,  dew  falls  in  considerable  quantity,  but  still  in  a  very  small 
proportion  when  compared  with  the  opposite  continent  of  America. 
In  Jamaica  dew  is  often  heavy,  and  Dr.  Melville  informs  me  that  it 
is  not  unfrequent  in  St.  Vincent's. 

The  range  of  atmospheric  pressure  is  remarkably  small.  At 
Antigua,  in  1818,  this  amounted  to  half  an  inch  only;  and,  accord- 
ing to  Dr.  Chisholm,  it  does  not  exceed  an  inch  in  any  year. 

Vrom  the  small  size  of  the  greater  number  of  these  islands,  there 
do  not  occur  the  regular  alternations  of  land  and  sea  breezes  which 
prevail  generally  in  tropical  climates,  but  the  same  circumstance 
admits  of  the  influence  of  the  easterly,  or  trade  wind,  without  inter- 
mission. This  wind  prevails,  with  great  regularity,  for  nine  months 
of  the  year.  During  August,  September,  and  October,  the  trade 
winds  are  much  more  irregular,  but  still  the  prevailing  wind  is 
decidedly  the  east.  It  is  chiefly  owing  to  the  full  influence  of  the 
trade  wind  that  the  climate  of  the  West  India  Islands  is  not  only 
tolerable,  but  infinitely  more  agreeable  than  Europeans  who  have 
never  visited  them  can  possibly  imagine,  when  the  temperature,  as 
indicated  by  the  thermometer,  is  alone  considered.  It  would  appear 
from  a  register  now  before  me,  kept  on  board  one  of  H.  M.  ships, 
that  the  temperature  of  the  air  at  sea  is  very  nearly  the  same  as  on 
the  small  islands.3 

We  have  now  to  inquire  into  the  influence  of  this  climate  on  dis- 
ease, and  more  epeoially  upon  Consumption. 

Respecting  the  prevalence  of  consumption  in  the  West  Indies, 
there  exists  considerable  difference  in  the  statements  of  those  who 
have  had  ample  opportunities  of  observation.  Dr.  Musgrave  remarks 
of  the  occurrence  of  phthisis  among  the  whites,  that  the  subjects  of 
it  are  almost  invariably  of  families  in  which  hereditary  predisposi- 
tion has  been  long  established.  Amongst  the  blacks,  Dr.  Musgrave's 
patients  have  been  chiefly  native  Africans,  disbanded  soldiers  for 
example,  or  their  immediate  offspring ;  the  Creole  negro  of  many 
generations  being  comparatively  free  from  pulmonary  disease  of 
every  kind. 

On  the  other  hand,  it  appears  from  the  Army  Reports,  that  nearly 
twice  as  many  cases  of  consumption  originate  among  our  troops  in 
the  West  Indies  as  at  home ;  twelve  per  thousand  of  the  aggregate 
strength  of  our  troops  serving  in  the  West  Indies  being  attacked 
annually,  while  of  the  Dragoon  Guards  serving  in  Great  Britain, 

1 1  am  informed  by  Dr.  Musgrave  that  such  are  now  in  progress  of  being 
made  by  his  colleague  Dr.  Nicholson. 

2  In  this  journal,  the  temperature  of  the  sea-water  is  often  noted  in  the 
harbours,  and  at  great  distances  from  land,  at  various  depths  short  of  100 
feet.  It  varied  from  76°  to  83°  5.  On  one  occasion  the  temperature  of  a 
torrent  of  rain  as  it  fell,  is  marked  77°,  the  temperature  of  the  air  being  78°. 


ATLANTIC  CLIMATES.  153 

the  proportion  is  only  six  and  a  half  per  thousand.  The  disease, 
according  to  the  same  reports,  is  even  of  more  frequent  occurrence 
among  the  black  than  the  white  troops. 

If  we  have  found  cause  to  condemn  Italy  as  a  summer  residence 
for  consumptive  patients,  there  seems  no  just  reason  why  we  should 
commend  the  West  Indies,  even  in  winter,  the  temperature  of  which 
is  above  the  summer  temperature  of  any  place  in  the  south  of 
Europe. 

More  extended  experience,  and  more  accurate  observation,  how- 
ever, than  has  hitherto  been  applied  to  the  cases  of  pulmonary  inva- 
lids sent  abroad,  can  alone  enable  us  to  speak  positively  on  this 
point.  In  the  mean  time,  every  thing  that  we  know  regarding  the 
nature  of  consumption,  and  the  influence  of  a  high  temperature  on 
it — supported  by  our  practical  experience  of  the  effects  of  the  cli- 
mate now  under  consideration,  bear  us  out  in  laying  it  down  as  a 
general  rule,  that  the  climate  of  the  West  Indies  is  an  improper  one 
for  patients  with  tuberculous  disease  of  the  lungs. 

As  my  own  personal  experience  on  the  subject  is  rather  limited, 
it  may  be  as  well  to  notice  the  opinions  of  those  whom  a  residence 
in  the  West  Indies  has  afforded  ample  opportunities  of  judging. 
Dr.  Hunter,  speaking  of  Jamaica,  observes: — "Pulmonary  con- 
sumptions rarely  originate  in  the  island,  but  those  who  come  from 
England  with  that  complaint  already  begun,  are  not  benefited  by 
the  warmth  of  the  climate ;  on  the  contrary,  the  disease  is  precipi- 
tated, and  proves  sooner  fatal  than  it  would  have  done  in  a  more 
temperate  air.  Of  this  we  had  repeated  examples  among  the  sol- 
diers, several  of  whom  arrived  in  the  island  with  beginning  con- 
sumptions, and  were  all  quickly  carried  off  by  that  disease."1  Dr. 
Musgrave  and  Dr.  Arnold  agree  in  this  opinion;  and  Dr.  Chisholm 
states,  that  catarrh,  pulmonic  inflammation, and  phthisis  pulmonalis, 
are  very  frequent  in  the  West  Indies;  that  these  diseases  are  very 
rapid  in  their  progress  ;  that  when  phthisis  is  fully  established,  there 
is  no  safety  in  remaining  in  the  climate.  A  sea  voyage,  and  tem- 
perate or  cool  climate,  presents  then  the  only,  or  at  least  the  best, 
chance  of  life.2  The  opinions  of  Dr.  Fergusson,  Sir  Alexander  Dick- 
son,  and  Dr.  M'Arthur  are  equally  strong  on  this  subject ;  and  these 
gentlemen,  as  well  as  Dr.  Chisholm,  had  peculiar  opportunities  of 
observing  the  effects  of  climate  on  a  very  large  scale.  Dr.  Fergusson 
had  the  direction  of  the  army  medical  department  in  these  islands 
for  several  years  ;  Sir  A.  Dickson  was  physician  to  the  fleet  in  the 
West  Indies  six  years,  and  Dr.  M' Arthur  had  charge  of  the  Royal 
Naval  Hospital  at  Barbadoes  for  six  years.  It  was  customary  in 
our  navy  at  that  time  to  draught  seamen,  labouring  under  chronic 
pulmonary  diseases,  into  ships  going  to  the  West  Indies ;  and  it 
was  constantly  observed,  that  the  progress  of  consumptive  cases,  to 
a  fatal  termination,  was  much  more  rapid  than  is  generally  observed 

1  Op.  citat.  8Op.  citat. 


154         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

in  more  temperate  climates.1  Dr.  Fergusson  remarked  the  same 
thing  among  the  military;  the  disease,  to  use  his  own  words, 
"  resembling,  in  its  progress,  an  acute  rather  than  a  chronic  affec- 
tion ;"  and  Sir  A.  Dickson's  language  is  equally  strong  on  this 
point. 

It  is  unnecessary,  I  presume,  to  adduce  further  evidence  to  prove 
the  injurious  effects  of  the  West  India  climate  on  confirmed  con- 
sumption. 

The  next  point  for  consideration  is  the  influence  of  this  climate 
on  persons  predisposed  to  consumption.  Those  who  have  had  the 
best  opportunities  of  judging,  are  in  favour  of  it  as  a  prophylactic 
means.  Dr.  Fergusson  who  had  extensive  opportunities  of  observ- 
ing the  influence  of  the  climate  upon  our  troops,  and  Dr.  Melville 
who  has  long  practised  in  St.  Vincent's,  are  of  this  opinion.  Dr. 
Musgrave,  who  has  practised  twenty-six  years  in  Antigua,  says, 
that  it  has  never  fallen  to  his  lot  to  see  a  single  case  of  consumption 
commencing  in  a  European,  whether  hereditarily  predisposed  or 
not,  who  had  arrived  in  the  West  Indies  in  perfect  health.  Dr. 
Arnold  found  the  climate  of  Jamaica  very  favourable  to  young  per- 
sons from  fifteen  to  twenty  years  of  age,  hereditarily  predisposed  to 
consumption. 

Dr.  Jackson,  of  Boston,  U.  S.,  whose  experience  has  been  some- 
what large,  thinks  favourably  of  the  West  Indian  climate  in  con- 
sumption ;  but  he  does  not  define  the  periods  of  the  disease  in 
which  he  finds  it  most  useful.  He  sends  patients  chiefly  to  Cuba  ; 
there  to  remain  till  the  last  of  April ;  then  to  change  to  Georgia,  or 
South  Carolina,  and  to  return  to  Boston  very  slowly,  so  as  not  to 
reach  New  England  till  the  end  of  June. 

Much  will  depend  upon  the  nature  of  the  constitution — whether 
it  is  such  as  is  calculated  to  bear  a  tropical  climate  well,  or  likely 
to  sink  under  the  irritating  and  exhausting  effects  of  heat.  When 
the  morbid  condition  of  the  system,  which  gives  reason  to  fear  the 
approach  of  phthisis,  depends  chiefly  upon  hereditary  predisposition, 
and  occurs  in  early  life,  especially  in  feeble  irritable  constitutions, 
the  climate  of  the  West  Indies  will  rarely  agree.  At  a  more 
advanced  period  of  life,  and  in  constitutions  free  from  much  disor- 
der of  the  nervous  system,  and  of  the  digestive  organs,  the  climate 
may  prove  useful.  The  revolution  effected  in  the  distribution  of 
the  circulating  fluids  and  in  the  secretions,  may  have  the  effect  of 
enabling  a  constitution  in  which  there  exists  considerable  powers, 
to  overcome  the  tuberculous  diathesis. 

Independently  of  the  nature  of  the  patient's  constitution,  other 
circumstances  will  deserve  consideration;  for  instance,  whether  the 
invalid  can  command  the  accommodations  and  comforts  necessary 

1  So  well  convinced  was  Dr.  M'Arthur  of  this,  that  he  thought  it  his  duty 
to  communicate  the  fact  officially  to  the  head  of  the  Naval  Medical  depart- 
ment; and  I  am  informed  by  Sir  William  Burnett,  Inspector  General  of  the 
Navy,  that  the  practice  of  sending  consumptive  sailors  to  this  and  other  hot 
climates  has  long  since  been  discontinued. 


ATLANTIC  CLIMATES.  155 

upon  a  voyage,  and  during  his  residence  in  the  West  Indies ; 
whether  he  may  have  the  power  of  selecting  a  proper  situation,  and 
of  quitting  the  country  on  the  approach  of  the  summer  heat,  &c. 

It  is  a  remarkable  fact,  confirmed  to  me  by  Drs.  Arnold  and 
Musgrave,  that  persons  obviously  predisposed  to  consumption  are 
rarely  attacked  by  the  indigenous  fever. 

The  cases  of  Pulmonary  Consumption,  therefore,  in  which  the 
climate  of  the  West  Indies  promises  advantage  are  very  few,  and 
their  character  scarcely  ascertained  ;  while  those  in  which  it  pro- 
duces mischief  are  numerous,  and  generally  well  marked.  Of  per- 
sons predisposed  to  the  disease,  a  certain  proportion  are  likely  to  be 
benefited  by  the  climate, — but  the  nature  of  the  constitution  should 
be  well  considered  before  it  is  recommended  even  as  a  prophylactic. 

The  affections  of  the  chest  most  likely  to  derive  benefit  from  a 
residence  in  the  West  Indies  are  chronic  diseases  of  the  bronchial 
membrane,  occurring  in  persons  otherwise  of  a  tolerably  sound  con- 
stitution. "  Persons,"  says  Dr.  M'Arthur,  "  labouring  under  chronic 
cough,  about  the  middle  period  of  life,  and  whose  health  is  other- 
wise good,  derive  much  benefit  from  the  climate."  In  asthma, 
however,  the  same  gentleman  has  generally  observed  the  climate 
injurious.  In  both  these  statements,  Dr.  Melville's  experience  leads 
him  to  coincide.  Dr.  Arnold,  however,  did  not  find  it  so  in  Jamaica, 
where  he  has  seen  many  cases  of  this  disease  benefited  by  the  cli- 
mate. I  have  not  myself  had  sufficient  experience  to  enable  me  to 
form  an  opinion  on  the  subject;  but  I  can  have  no  doubt  that  the 
cases  in  which  the  climate  will  prove  most  useful,  are  those  in 
which  the  disease  is  chiefly  confined  to  the  bronchial  rnembrane; 
and  in  which  the  digestive  organs  are  in  a  sound  state. 

In  stomach  complaints  the  West  Indies  are  very  generally  unfa- 
vourable. The  extreme  activity  of  the  cutaneous  circulation,  ex- 
cited and  kept  up  by  the  great  heat  of  the  atmosphere,  although  it 
may  diminish  internal  congestion,  induces,  I  am  inclined  to  think, 
after  a  time,  an  irritable  condition  of  the  mucous  membrane  of  the 
stomach  and  bowels,  combined  with  a  state  of  relaxation,  which 
greatly  predisposes  to  dyspepsia,  dysentery,  and  other  disorders  of 
the  abdominal  viscera,  and  to  gastric  fevers  : — diseases  which  make 
up  almost  the  sum  of  mortality  among  Europeans  in  the  West 
Indies.  At  the  same  time  I  do  not  mean  to  deny  that  in  certain 
cases  of  dyspepsia,  of  long  standing,  a  residence  in  this  climate  may 
prove  beneficial ;  just  as  we  find  other  great  changes,  of  various 
and  even  opposite  kinds,  in  the  condition  of  the  individual,  effect  a 
cure  in  this  and  other  diseases,  of  which,  in  our  limited  knowledge 
of  the  animal  economy,  we  are  unable  to  render  a  satisfactory 
explanation. 

Chronic  Rheumatism. — The  marked  benefit  derived  in  this  dis- 
ease from  a  mild  climate,  probably  led  to  the  belief  that  the  West 
India  and  other  tropical  climates  would  prove  still  more  beneficial. 
Experience,  however,  has  not  justified  the  expectation.  While 
some  cases  of  the  disease  are  benefited  by  the  climate  of  the  West 


156         CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

Indies,  others  are,  on  the  contrary,  aggravated  by  it.  When  the 
rheumatic  affection  is  symptomatic  of,  or  accompanied  with,  an 
irritable  state  of  the  digestive  organs,  or  a  feeble  relaxed  state  of 
the  system,  the  climate  will  disagree.  "  Chronic  rheumatism,"  says 
Dr.  M'Arthur,  "  when  the  general  health  is  unimpaired,  is  much 
relieved,  but  when  the  health  is  deteriorated,  the  powers  of  the 
digestive  organs  much  weakened,  or  the  disease  attended  with  pro- 
fuse perspirations,  nothing  but  a  return  to  a  cooler  climate  can  save 
the  patient."  In  my  own  opinion,  the  climate  is  too  hot  for  the 
generality  of  rheumatic  patients.  Our  soldiers  and  sailors  are  fre- 
quently invalided  from  the  West  Indies  on  account  of  rheumatism. 
Dr.  Grainger  says  that  this  disease,  in  the  chronic  form,  is  more 
prevalent  there  than  in  this  country,  especially  sciatica ;  and  Dr. 
Wright  adds,  that  acute  rheumatism  is  frequent  in  the  West  Indies.1 
Hereditary  gout,  Dr.  Musgrave  says,  is  often  as  severe  in  the  West 
Indies  as  in  England.  On  the  other  hand,  Dr.  Arnold  states  that 
gout  and  rheumatism,  according  to  his  experience,  are  of  rare 
occurrence  in  Jamaica,  and  he  has  known  many  cases  of  these  dis- 
eases benefited  by  a  temporary  residence  in  the  West  Indies ;  but 
in  Jamaica  it  is  to  be  remarked,  rheumatic  affections  are  much  less 
prevalent  among  our  troops  than  in  the  Windward  and  Leeward 
Command,  or  in  Great  Britain. — Army  Reports. 

Calculous  disorders  are  rare  in  the  West  Indies.  Dr.  Musgrave 
has  met  with  stone  in  the  bladder  once  only,  but  he  has  seen  several 
cases  in  which  renal  calculi,  after  the  usual  symptoms,  were  passed 
by  the  urethra.  Dr.  Arnold,  during  an  extensive  practice  in  Jamaica 
of  twenty  years,  met  with  two  cases  only  of  calculus.  Diseases  of 
the  heart  and  large  vessels  are  also  rare,  and  the  osseous  deposits, 
which  are  so  generally  found  in  the  coats  of  the  larger  arteries  in 
persons  who  die  at  an  advanced  age  in  cold  climates,  are  said  to  be 
rarely  met  with  in  those  who  die  at  a  similar  age  in  the  West 

T         I-  & 

Indies. 

The  climate  generally  proves  serviceable  in  scrofula,  which  is  a 
rare  disease  in  the  West  Indies.  Dr.  Fergusson,  in  particular, 
speaks  in  strong  terms  of  the  beneficial  effects  which  he  has  ob- 
served the  climate  produce  in  scrofulous  diseases;  Dr.  Melville 
coincides  in  this ;  but  Dr.  Arnold  limits  the  utility  of  the  climate  to 
incipient  states  only. 

In  the  higher  districts  of  the  interior  of  Jamaica  the  children  are 
uncommonly  fine;  and  the  children  of  Europeans  and  Creoles 
continue  to  thrive  well  till  they  attain  the  age  of  eight  or  nine 
years,  after  which  they  generally  begin  to  droop.  At  this  age, 
therefore,  children  should  be  sent  to  a  more  temperate  climate.  Dr. 
Arnold  remarks  that  the  diseases  of  childhood,  measles,  scarlatina, 
&c.,  are  generally  mild. 

To  persons   of  weak  irritable  constitutions,   or  with  irritable 

1  Essay  on  the  More  Common  West  India  Diseases,  by  James  Grain- 
ger, M.  D. 


ATLANTIC  CLIMATES.  157 

bowels,  or  deranged  digestive  organs  generally,  or  with  an  irritable 
skin,  or  subject  to  cutaneous  eruptions  of  an  irritable  character,  or 
too  copious  perspirations,  the  West  Indies  will  prove  injurious. 
Persons  subject  to  severe  headaches,  or  who  have  any  hereditary 
disposition  to  cerebral  disease,  or  to  insanity,  and  fair  plethoric 
people  generally,  should  also  avoid  the  tropics. 

Having  given  an  account  of  the  climate  of  the  West  Indies,  in 
general,  I  shall  now  notice  the  islands  which  are  considered  the 
most  healthy,  and  where  invalids  may  obtain  all  the  advantages 
which  the  climate  affords.  These  are  Jamaica,  Barbadoes,  St.  Vin- 
cent's, Antigua,  and  St.  Kitt's. 

In  many  other  islands  there  are,  perhaps,  to  be  found  situations 
equal  in  point  of  salubrity  to  any  of  these ;  and  there  are  among 
the  small  islands  more  than  one  entirely  free  from  all  endemic 
sources  of  disease.1  Yet  the  islands  just  named  possess  advantages, 
which,  upon  the  whole,  render  them  preferable  to  all  the  others  as 
the  resort  of  invalids.  Of  these,  St.  Vincent's  and  St.  Kitt's  are 
mountainous ;  Barbadoes  and  Antigua  are  low  islands.  As  St. 
Vincent's  lies  in  the  vicinity  of  Barbadoes  and  Antigua,  near  St. 
Kitt's,  the  invalid  may  without  much  inconvenience  or  difficulty 
change  his  residence,  and  in  some  degree  his  climate,  by  passing  to 
the  higher  situations  in  the  neighbouring  mountain  island,  and  the 
reverse.  This,  as  we  shall  have  occasion  to  show,  is  a  matter  of 
considerable  importance. 

Jamaica. — On  account  of  the  size  of  the  island,  and  the  height  of 
its  central  ridge  of  mountains,2  the  climate  of  Jamaica  differs  in 
some  respects  from  that  of  the  other  islands.  It  has  a  greater  range 
of  temperature,  and,  therefore,  a  greater  variety  of  climate.  There 
is  a  considerable  difference  between  the  lower  and  higher  parts, 
and  between  the  north  and  south  sides  of  the  island.  It  has  also 
the  advantage  of  a  sea  and  land  breeze,  which  the  smaller  islands 
have  not.  Dews  are  abundant.  More  rain  falls  on  the  north  than 
on  the  south  side  of  the  island.  On  an  average  of  five  years  it 
rained  116  days;  the  fall  is  50  inches.  The  difference  of  tempera- 
ture between  the  north  aiad  south  sides  of  the  island  amounts  to  5° 
during  the  whole  year,  and  in  the  first  three  months  of  the  year  to 
from  8°  to  10°. 

In  the  mountainous  districts  of  St.  Andrew  and  Port  Royal,  there 

1  Of  this  kind  is  one  of  the  small  islands  called  the  Saintes,  situated 
between  Guadaloupe  and  Dominica,  which  possesses  an  excellent  harbour. 
But  there  are  here  no  accommodations  for  invalids. 

2  The  altitude  of  the  highest  of  the  three  peaks  of  the  Blue  Mountains  is 
8,500  feet  above  the  level  of  the  sea. 

The  temperature  averages,  from  January  to  April,  in  the  early  morning 
55°,  in  the  afternoon  70°  j 

From  April  to  June  60°,  in  the  afternoon  75° 
„    June  to  Sept.  65°,  ditto,         80° 

„     Sept.  to  Dec.  65°,  ditto,         75° 

This  may  be  considered  the  mean  temperature  of  a  series  of  years. 


158         CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

are  residences  and  settlements,  three  or  four  thousand  feet  above 
the  level  of  the  sea,  where  the  air  is  temperate  and  salubrious  all  the 
year  round,  but  more  particularly  from  the  month  of  January  to  the 
end  of  May.  Probably  the  most  healthy  district  is  the  mountainous 
part  of  the  parish  of  St.  Ann,  which  is  nearly  in  the  centre  of  the 
island. 

The  mean  temperature  of  the  year  at  this  place  is  76°.  It  is 
generally  speaking  a  dry  district ;  there  are  no  morasses  or  jungle, 
and  the  carriage  roads  are  excellent. 

Convalescents  from  other  parts  of  the  island  often  derive  consi- 
derable benefit  from  a  residence  of  a  few  weeks  only  in  this  region. 
It  is  also  a  safe  temporary  retreat  for  consumptive  as  well  as  other 
invalids. 

Lucea  also,  has  a  high  reputation  for  salubrity  among  the  inha- 
bitants, and  is  often  resorted  to  by  convalescents ;  the  climate  is 
cool  and  pleasant  except  during  the  months  of  July,  August  and 
September. 

Rarbadoes  is  one  of  the  healthiest  islands;  it  is  almost  entirely 
free  from  marshy  grounds ;  and,  from  being  cultivated  throughout, 
and  comparatively  level,  it  affords  more  opportunities  of  exercise 
than  many  of  the  others.  The  capital,  Bridgetown,  although  more 
healthy  than  most  of  the  sea-ports  in  this  country,  is  the  most 
unhealthy  spot  in  the  island.  It  should,  therefore,  be  avoided  as  a 
residence  by  the  invalid.  Speightstown,  on  the  northwestern  ex- 
tremity of  the  island,  is  the  best  residence  in  the  form  a  town ; 
but  if  accommodations  could  be  found,  the  higher  grounds  in 
the  interior  of  the  island  possess  many  advantages.  The  part 
of  the  island  called  Scotland  is  from  600  to  800  feet  above  the 
level  of  the  sea,  and  is  constantly  perflated  by  the  trade  wind. 
It  is  therefore  cooler  than  the  lower  parts  of  the  island,  without 
being  subject  to  the  great  and  sudden  alternations  of  temperature, 
which  are  experienced  in  the  more  elevated  situations  of  the 
mountainous  islands.  This  district  is  also  remarkably  healthy. 
So  high  an  opinion  did  Dr.  Fergusson  form  of  the  salubrity  of  this 
spot,  he  informs  me,  that  after  a  careful  topographical  survey  of  the 
whole  Caribbean  Archipelago,  with  which  he  was  occupied  three 
years,  he  recommended  it  officially  to  government  as  the  best  situa- 
tion for  establishing  a  general  convalescent  depot,  for  the  debili- 
tated invalid  troops  of  all  the  other  islands,  instead  of  sending  them 
to  Europe  as  was  the  usual  custom. 

Notwithstanding  the  uniformity  of  temperature  which  prevails 
among  these  islands,  the  effect  of  a  change  from  one  to  another  is 
often  very  remarkable  in  improving  the  health.  This  has  been 
observed  frequently,  on  a  large  scale,  among  our  troops  stationed  in 
the  West  Indies ;  and,  indeed,  I  believe,  one  of  the  most  powerful 
means  of  diminishing  the  sickness  among  our  troops  in  that  climate, 
would  be  to  remove  them  frequently  from  one  healthy  island  to  an- 
other ;  or  still  better,  send  them  to  sea  for  a  few  weeks. 

St.  Vincent's  lies  directly  to  the  westward  of  Barbadoes,  from 


ATLANTIC  CLIMATES.  159 

which  it  is  distant  only  a  few  hours  sail.  Its  capital,  Kingston,  is 
almost  peculiar,  Dr.  Fergusson  remarks,  in  being  built  in  a  healthy 
site  on  the  shores  of  a  fine  bay.  A  cool  situation  may  be  found  by 
ascending  the  mountains  which  compose  the  greater  bulk  of  this 
beautiful  and  romantic  island.  But  here  the  difficulty  of  finding 
accommodations  will  be  still  greater  than  in  the  higher  parts  of 
Barbadoes. 

Antigua,  although  one  of  the  low  islands,  is,  in  many  parts,  con- 
siderably more  elevated  than  Barbadoes.  There  are  some  unhealthy 
spots  in  this  island,  but  the  greater  part  of  it  is  healthy;  and  many 
positions  on  its  rounded  hills  favourable  to  health  may  be  found. 
The  fall  of  rain  is  forty-five  inches.  Dryness  of  atmosphere  cha- 
racterises the  climate  both  of  Barbadoes  and  Antigua.  Antigua 
bears  the  same  relation,  in  point  of  elevation,  to  St.  Kitt's,  that 
Barbadoes  does  to  St.  Vincent's.  .The  climate  of  Antigua,  accord- 
ing to  the  Army  Reports,  may  be  considered  as  more  favourable 
both  to  white  and  black  troops  than  most  of  the  others  in  the 
command. 

St.  Kitts,  (or  St.  Christopher's)  is  one  of  the  most  beautiful 
islands  in  the  West  Indies,  rivaling  Barbadoes  in  many  respects, 
and  excelling  it  in  others,  as  a  residence  for  invalids.  Indeed, 
among  my  medical  friends,  who  have  visited  the  Caribbean  Islands, 
I  think  the  greater  number  give  this  island  the  preference  over  all 
the  others,  certainly  over  all  the  high  islands.  The  greater  part  of 
St.  Kitt's  is  healthy ;  and  from  its  mountainous  character,  it  affords 
the  invalid  an  opportunity  of  seeking  a  cooler  climate  ;  but  here, 
unfortunately,  the  means  of  accommodation  are  greatly  limited  ; 
and  we  speak  rather  of  what  it  might  afford,  than  what  it  really 
possesses.  A  situation  of  this  kind,  called  Spooner's  Level,  is 
described  by  Dr.  Fergusson,  in  a  written  communication  to  me,  as 
embosomed  in  the  great  volcanic  central  ridge,  which  divides  the 
island  longitudinally ;  and  at  an  elevation  of  1400  feet  above  the 
level  of  the  sea,  in  a  climate,  and  amid  scenery  truly  beautiful, 
affording  the  most  delightful  atmosphere  which  he  ever  breathed. 
St.  Kitt's  has  also  the  advantage  of  excellent  roads.  Considering 
all  things,  St.  Kitt's,  as  a  high,  and  Barbadoes  as  a  low  island, 
appear  to  deserve  the  preference  over  all  the  other  small  islands. 
But  a  more  advantageous  and  better  plan  for  the  invalid,  than 
residing  in  any  one  island,  would  be  to  cruize  among,  or  make 
short  visits  to  the  different  islands.  St.  Kitt's,  from  its  situation 
among  a  group  of  islands,  is  well  situated  for  the  head  quarters  of 
an  invalid,  having  such  a  plan  in  view. 

The  little  island  of  Nevis,  in  the  immediate  vicinity  of  St.  Kitt's, 
and  similar  to  it  in  its  physical  characters,  deserves  perhaps  to  be 
mentioned.  It  is  considered  very  healthy. 

By  referring  to  what  has  been  stated  respecting  the  seasons  in 
the  West  Indies,  the  proper  time  for  the  residence  of  the  invalid  in 
that  country  will  be  found  to  be  from  the  beginning  of  December 
to  the  end  of  April.  This  period  is  alone  suited  to  invalids  who 


160        CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

visit  the  West  Indies  for  the  recovery  of  their  health.  It  is  the 
coolest  and  most  healthy  part  of  the  year, — the  epithet  healthy 
being  applied  to  it,  in  contradistinction  to  the  autumn,  which  is 
termed  the  unhealthy  season,  from  being  the  time  during  which 
the  endemic  diseases,  which  are  the  scourge  of  the  West  Indies, 
prevail  with  the  greatest  force.  By  leaving  England  in  the  end  of 
October,  or  beginning  of  November,  the  invalid  would  reach  the 
West  Indies  at  the  proper  season  ;  and  he  should  contrive,  if  pos- 
sible, not  to  return  to  this  country  until  the  end  of  June. 

Before  concluding  the  subject  of  the  West  Indies,  it  may  be  well 
to  add  a  few  remarks  on  the  management  of  the  invalid  during  his 
voyage  to,  and  residence  in  these  islands,  as  this  is  a  subject  on 
which  he  is  likely  to  receive  very  contradictory,  and  often  very 
erroneous  counsel. 

On  approaching  the  tropics,  when  about  the  25th  or  24th  degree 
of  latitude,  where  the  temperature  ranges  from  70°  to  80°,  a  degree 
of  general  excitement  is  very  often  experienced,  and  a  disposition 
to  catarrhal  affections  which  demands  particular  attention  on  the 
part  of  the  invalid  labouring  under  any  chronic  pulmonary  disease. 

The  proper  means  to  prevent  any  injurious  effects  from  the  in- 
crease of  temperature,  is  to  live  somewhat  more  abstemiously  than 
usual,  and  upon  less  exciting  food.  The  quantity  of  wine  generally 
drunk  should  be  diminished,  or  it  may  be  advisable  to  abstain  from 
wine  altogether.  Long  exposure  to  the  direct  rays  of  the  sun, 
should  also  be  avoided.  Attention  to  these  circumstances,  with  the 
use  of  a  little  cooling  laxative  medicine,  will  generally  be  all  that  is 
necessary  on  arriving  in  the  West  Indies.  For  some  time  after- 
wards a  continuance  of  the  same  simple,  unexciting  regimen, 
should  be  persevered  in,  in  order  that  the  system  may  become 
habituated  to  the  exciting  influence  of  a  high  temperature,  and 
until  the  increased  cutaneous  secretion,  which  appears  to  be  one  of 
the  principal  means  employed  by  nature  to  enable  the  living  body 
to  bear  the  heat  of  a  tropical  climate  without  injury,  is  fully  esta- 
blished. Whether  approaching  or  residing  in  the  West  Indies,  this, 
says  Dr.  Arnold,  is  the  grand  secret  for  the  preservation  of  health, 
and  to  the  neglect  of  it,  and  the  adoption  of  an  opposite  mode  of 
living,  is  to  be  attributed  in  a  great  degree  the  sickness  and  mor- 
tality among  the  European  residents  in'these  islands,  arid  indeed  in 
all  tropical  climates.  Exercise  in  the  middle  of  the  day,  and  expo- 
sure to  currents  of  air  while  in  a  state  of  perspiration,  should  be 
carefully  avoided.  From  these  two  causes,  and  an  over-exciting 
diet,  are  produced  a  great  proportion  of  the  diseases  which  prove  so 
fatal  to  Europeans  in  the  West  Indies.  With  respect  to  clothing,  it 
is  now  universally  admitted,  I  believe,  by  those  who  have  resided 
in  a  tropical  climate,  that  flannel  is  the  safest  and  best  covering 
next  the  skin.  Although  the  general  temperature  of  the  winter  is 
very  high,  yet  dry,  cool  winds,  frequently  occur,  and  give  rise  to 
catarrhal  and  other  inflammatory  affections  of  the  lungs.  In  March 
and  April,  when  the  greatest  difference  exists  between  the  tempera- 


ATLANTIC  CLIMATES.  161 

ture  of  the  day  and  night.  Dr.  Hunter  found  catarrhs  frequent  in 
Jamaica.  Dr.  Chisholm  states,  that  in  those  parts  of  the  islands 
especially  which  are  exposed  to  the  sharp  northerly  winds  of  the 
spring,  called  norths^  the  inhabitants  are  annually  afflicted  at  that 
season  with  pulmonary  and  hepatic  inflammation.  He  adds  further, 
that  it  is  a  grievous  error  to  believe  that  catarrhal  complaints  are 
rare  in  the  torrid  zone;  and,  in  addition  to  his  own  experience,  he 
cites  that  of  M.  Desportes,  an  intelligent  French  physician,  who 
practised  many  years  in  the  island  of  St.  Domingo,  who  observes 
that  "  les  habitans  des  pays  chauds  sont  encore  plus  sujets  aux 
catarrhes  que  ceux  des  temperes."  A  medical  friend,  who  long 
enjoyed  an  extensive  practice  in  Barbadoes,  and  to  whom  I  am 
indebted  for  some  useful  information  on  the  subject  of  this  article, 
informs  me,  that  epidemic  catarrhs  are  frequent  in  that  island,  and 
often  prove  fatal  to  the  black  inhabitants  ;  and  Hillary  also  describes 
catarrhal  fevers  as  of  frequent  occurrence  in  Barbadoes  in  his  time, 
and  often  epidemic,  spreading  over  the  whole  island,  and  sparing 
neither  whites  nor  blacks. 

It  must  not  be  believed  from  this,  that  Barbadoes  is  more  subject 
to  catarrhal  affections  than  the  other  islands  ;  they  have  only  been 
better  described.  Dr.  Grainger,  who  practised  in  St.  Kitt's,  observes, 
that  coughs  are  common  in  the  West  Indies,  from  the  latter  end  of 
October  to  the  latter  end  of  February.1  Dr.  Arnold,  in  his  work, 
has  also  remarked  the  occurrence  of  bronchial  affections  in  Jamaica, 
but  describes  them  as  mild  compared  to  the  same  diseases  in  Eng- 
land, and  as  being  curable  by  very  mild  treatment.2  Dr.  Musgrave 
agrees  in  this,  and  says  that  epidemic  influenza  sometimes  prevails, 
but  is  a  mild  disease,  easily  yielding  to  the  simplest  remedies. 

There  is  one  circumstance  in  the  character  of  tropical  diseases, 
which  the  European  visiting  these  colonies  should  be  fully  im- 
pressed with,  and  that  is,  their  violence  and  very  rapid  progress. 
This  is  more  especially  the  case  with  fevers  and  inflammations ;  in 
such  cases,  the  remedies  require  to  be  applied  early,  and  with  an 
energy  proportioned  to  the  violence  of  the  disease.  On  this  account 
it  is  advisable  to  call  in  medical  advice  the  moment  disease  makes 
its  attack. 

From  what  has  been  said,  it  is  manifest,  that  he  who  visits  the 
West  Indies,  more  especially  with  a  view  to  the  restoration  of  his 
health,  requires  to  conduct  himself  with  great  circumspection.3 
Nor  must  his  care  cease  with  leaving  these  islands.  On  returning 
to  this  country,  he  has  to  guard  against  the  effects  of  the  change  of 

1  Op.  chat. 

2  A  Practical  Treatise  on  the  Bilious  Remittent  Fever,  &c.     To  which  is 
added,  Medical  Topography  of  the  Different  Military  Stations  in  Jamaica. 
London,  1840. 

3  For  more  detailed  information  respecting  tropical  diseases  and  hygiene, 
the  reader  is  referred  to  Dr.  James  Johnson's  comprehensive  and  valuable 
work,  The   Influence   of  Tropical   Climates   on  European  Constitutions. 
Fifth  Edition,  London,  1836. 

2— d  11  dark 


162         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

climate,  and  must  provide  for  it  by  suitable  clothing.  In  this  respect 
he  should  anticipate  the  change  of  climate;  and  avoid  exposing 
himself  long,  on  deck,  to  damp,  cold  winds.  The  complaints  most 
likely  to  attack  persons  returning  from  a  hot  to  a  cold  or  temperate 
climate  are  diarrhoea,  catarrh,  and  rheumatism,  or  a  relapse  of  any 
disease  to  which  the  person  had  been  subject.  All  these  may  be 
prevented  by  warm  clothing,  attention  to  diet,  and  avoiding  unne- 
cessary exposure  in  cold  and  damp  weather, 


APPENDIX. 


I. 

CLIMATES  OP  THE  SOUTHERN  HEMISPHERE, 


I  have  limited  my  observations  in  the  foregoing  pages  to  the 
climates  of  the  Northern  Hemisphere ;  but  the  Southern  Hemisphere 
also  affords  climates  in  every  way  congenial  to  the  European  con- 
stitution, and  calculated  to  exert  on  the  health  the  same  beneficial 
influence  as  the  best  northern  climates.  The  Cape  of  Good  Hope, 
Australia,  and  New  Zealand,  present  themselves  for  choice  among 
the  British  possessions,  and  offer  peculiar  advantages  to  those  whose 
inclination  or  circumstances  lead  them  to  seek  a  permanent  settle- 
ment in  the  climate  which  is  most  likely  to  suit  their  constitution. 

Although  we  have  not  any  very  extensive  data  by  which  to  esti- 
mate the  precise  characters  of  the  climates  of  these  different  regions, 
we  yet  have  the  experience  of  a  considerable  period,  during  which, 
with  the  exception  of  New  Zealand,  the  countries  above  named 
have  been  inhabited  by  the  English ;  and  even  respecting  New  Zea- 
land we  possess  information  which  enables  us  to  form  a  tolerably 
accurate  opinion  of  the  climate,  and  its  influence  on  the  health  of 
natives  of  this  country,  and  to  compare  it  with  the  other  places 
referred  to  in  the  Southern  Ocean. 

From  the  situation  south  of  the  Equator  of  the  countries  under 
consideration,  their  seasons  are  the  reverse  of  ours.  Thus  August, 
September,  and  October  constitute  the  Spring  months ;  November, 
December,  and  January,  Summer ;  February,  March,  and  April, 
Autumn ;  and  May,  June,  and  July,  Winter, 

CAPE  OP  GOOD  HOPE. 

For  the  few  remarks  to  be  made  on  the  climate  of  the  Cape  I  am 
indebted  chiefly  to  the  Army  Returns,  so  often  referred  to. 


164 


CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 


The  range  of  the  thermometer  at  Cape  Town,  taken  on  the 
average  of  seven  years  (1827 — 33),  was  as  under: — 


Months. 

Jan. 

Feb. 

Mar. 

Apr. 

May 

Jun. 

July 

Aug. 

SepJOct. 

Nov 

Dec. 

Max.  .  . 

86 

84| 

82 

78 

73 

67i 

65^ 

67 

68 

72i 

77 

80 

Med.  .  . 

78 

76i 

75 

71 
65^ 

66^ 
61 

61 

57 

59  1 
56 

61 
56 

62£ 
57 

65^ 
60 

70 
63 

74 
69 

Min.  .  . 

72  £ 

70 

68£ 

A  table  such  as  this,  however,  which  only  indicates  the  range  of 
the  thermometer  in  the  shade,  cannot  convey  any  adequate  idea  of 
the  intense  heat  occasioned  by  the  reflection  of  the  sun's  rays  from 
the  adjacent  mountains. 

The  character  of  the  atmosphere  is  that  of  dryness;  but  the 
scarcity  of  rain  and  moisture,  which  renders  a  great  part  of  the 
interior  in  certain  seasons  a  barren  desert,  is  much  less  experienced 
in  the  Cape  district.  The  average  number  of  days  on  which  rain 
fell  during  a  series  of  years,  was  seventy-five,  and  the  quantity 
which  fell  averaged  41  inches,  annually. 

The  most  common  winds  at  Cape  Town  are  from  the  southeast 
and  northwest.  The  former  is  the  prevailing  wind  of  the  summer 
season,  and  from  its  blowing  over  the  sandy  flats  between  the  town 
and  Simon's  Bay,  is  usually  sultry,  relaxing,  and  debilitating ;  the 
latter,  the  prevailing  wind  of  the  winter  months,  being  a  sea-breeze, 
is  cold,  chilly,  and  often  accompanied  by  heavy  falls  of  rain  and 
violent  gales. 

Southwesterly  winds  prevail  during  spring  and  autumn,  and 
from  passing  over  the  wide  expanse  of  the  Southern  Ocean  are 
generally  surcharged  with  moisture,  which  wraps  the  summits  of 
the  mountains  over  Cape  Town  in  dense  fogs.  As  the  upper  stratum 
of  the  air  becomes  cooled,  the  fogs  rapidly  descend  in  tempestuous 
blasts,  causing  an  immediate  reduction  of  temperature,  with  an 
equally  sudden  transition  from  an  extremely  dry  to  a  damp  raw 
state  of  atmosphere.  These  winds  are  often  accompanied  with 
rain,  which,  however,  is  never  so  heavy  as  -that  brought  by  the 
winter  wind,  being  only  what  is  commonly  known  by  the  name  of 
a  "  Scotch  mist !" 

From  the  Army  Reports  it  appears,  that  the  climate  of  the  Cape 
district  is  at  least  as  favourable  to  the  health  as  that  of  Britain. 
Fevers  of  the  intermittent  and  remittent  type  are  extremely  rare 
among  the  troops,  and  unknown  among  the  inhabitants.  The 
troops  are  less  subject  to  diseases  of  the  lungs  at  Cape  Town  than 
in  our  other  colonies ;  and  there  is  a  smaller  proportion  of  deaths 
from  consumption  than  has  been  observed  on  any  foreign  station, 
except  the  East  Indies.  Rheumatism,  which  is  more  frequent 
among  the  civil  inhabitants  even  than  among  the  troops,  prevails 
among  the  latter  to  a  greater  extent  than  at  home,  or  in  the  other 
colonies. 


SOUTHERN  HEMISPHERE. 


165 


The  Eastern  Province,  including  the  new  settlement  of  Albany, 
although  subject  to  sudden  variations  of  temperature,  is  in  an  emi- 
nent degree  favourable  to  the  European  constitution.  From  the 
Army  Reports  as  well  as  from  what  is  known  in  regard  to  the  mor- 
tality among  the  civil  population,  there  can  be  no  doubt  that  this 
portion  of  the  colony  is  more  favourable  to  health  than  the  United 
Kingdom.  The  low  ratio  of  sickness  and  mortality  among  the 
troops  has  been  mainly  attributable  to  the  extreme  rarity  of  diseases 
of  the  lungs.  Pneumonia  and  consumption  in  particular  are  still 
less  frequent  than  at  Cape  Town.  Fevers  also  are  even  more  rare 
and  less  fatal,  but  rheumatic  diseases  are  exceedingly  common.1 

The  places  chiefly  resorted  to  by  invalids  from  India  and  Eng- 
land at  the  Cape  of  Good  Hope,  are  Rondebosch,  about  five,  and 
Wynberg  about  eight  miles  from  Cape  Town.  At  both  places 
there  are  many  comfortable  commodious  houses  to  be  hired,  and 
three  public  boarding-houses.  There  is  a  church  at  each  place, 
and  good  English  society.  Living  is  very  moderate. 

These  places  are  much  cooler  than  Cape  Town,  chiefly  owing  to 
their  being  open  to  the  southeast  wind,  which  blows  nearly  the 
whole  summer. 

There  are  shady  walks  and  rides,  but  the  roads  are  very  dusty. 

The  following  will  give  an  idea  of  the  climate  to  be  obtained 
during  the  summer  months.  The  observations  were  taken  in  a 
sitting-room  at  Rondebosch,  door  and  windows  generally  open,  not 
much  exposed  to  the  sun,  by  the  late  Rev.  Mr.  Ash — 


Aver.  Range  of 
24  hours. 

Aver.  tern, 
at  2  o'clock. 

Extr 
rain. 

ernes, 
max. 

Rain  fell  on 

From  Dec.  17th  to> 
Dec.  31st.   .  .    5 

65£  to  69 

68 

61 

77 

2  days 

67i  to  70} 

69i 

65 

76 

7  days 

February^  
March    .  .  .  .  •«*  V  v^ 

67f  to  71$ 

69| 

65 

78£ 

7  days 

65f  to  69J- 

67T%- 

61 

74 

7  days 

AUSTRALIAN  CLIMATE. 

In  a  tract  of  country  of  such  extent  as  Australia,  various  climates 
must  necessarily  be  found.  The  settled  districts  are  between  the 
30th  and  43d  degrees  of  south  latitude,  and  possess  generally  a 

'  In  regard  to  the  frequency  of  rheumatism  at  the  Cape,  Dr.  Smith  says, 
in  a  letter  to  me,  "that  he  is  much  disposed  to  attribute  it  to  the  injudicious 
practice  which  prevails,  among  persons  of  all  classes,  of  seeking  comfort  in 
currents  of  cold  air  while  in  a  state  of  perspiration,  and  often  while  much 
of  their  clothing  is  thrown  off."  It  is  to  be  remarked,  that  in  New  South 
Wales,  which  is  similar  to  the  Cape  in  point  of  climate,  rheumatism  is  also 
prevalent  and  severe. 


166 


CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 


climate,  which,  though  it  maybe  characterised  as  temperate,  and 
such  as  is  congenial  to  the  European  constitution,  presents  several 
peculiarities. 

New  South  Wales. — We  are  better  acquainted  with  the  climate 
of  New  South  Wales  than  of  any  other  part  of  Australia. 

One  peculiarity  of  the  climate,  is  its  liability  to  occasional  great 
droughts,  for  instance  five  months  without  rain,  as  in  1826.  An- 
other evil  of  the  climate  is  the  occasional  prevalence  of  dry  sultry 
winds. 

"The  most  singular  phenomenon,"  says  Dr.  Lang.  uin  the 
meteorology  of  New  South  Wales,  is  the  occasional  prevalence  of 
hot  winds  from  the  northwestward.  These  winds  occur  on  an 
average  four  times  every  summer,  and  blow  from  twenty-four  to 
thirty-six  hours  each  time,  the  atmosphere  all  the  while  feeling  like 
a  current  of  heated  air  from  a  furnace,  and  the  thermometer  gene- 
rally standing  at  from  90°  to  100°  of  Fahrenheit.  It  has  even  stood 
as  high  on  one  occasion,  within  my  own  experience,  as  112^°. 
This  hot  wind  is  usually  succeeded  suddenly  by  a  wind  from  the 
south,  which  causes  the  mercury  in  the  thermometer  to  descend 
with  great  velocity."1 

The  following  table  for  Sidney  affords  a  pretty  good  idea  of  the 
climate  as  regards  temperature  : — 

Means  of  the  Thermometer,  from  May,  1821,  to  April,  1822, 
according  to  Major  Goulburn ;  and  from  May,  1822,  to  May, 
1823,  according  to  Sir  Thos.  Brisbane. 

Goulburn.  Brisbane.  Mean. 

January 72.14  72.86  7^.50 

February 73.04  68.36  70.70 

March 71.80  59.90  65.85 

April 67.46  59.00  63.23 

May 61.16  59.90  60.53 

June 57.20  53.42      *     55.31 

July 55.04  51.44  53.24 

August 54.86  56.48  55.67 

September 60.98  61.88  61.43 

October 64.76  68.00  66.38 

November 65.84  71.96  68.90 

December 72.14  73.94  73.04 

Summer 72.50  71.78  72.14 

Autumn 66.20  59.54  62.87 

Winter 61.34  52.78  57.56 

Spring 63.86  67.28  65.57 

Annual 64.40  63.14  63.68 

The  observations  of  Goulbourn  were  made  at  three  different 
hours,  viz.  six  o'clock  A.  M.,  noon,  and  eight,  p.  M. 

• 

1  Historical  and  Statistical  Account  of  New  South  Wales.    London,  1837. 


SOUTHERN  HEMISPHERE.  167 

Yearly  mean  for  6  A.  M 63.14 

do.'        do.          Noon 65.48 

do.        do.        8  P.  M 64.94 

This  shows  how  small  the  daily  range  of  temperature  is. 

Fall  of  Rain. — The  following  was  the  number  of  days,  accord- 
ing to  Goulburn,  in  each  month  on  which  rain  fell  during  the  year, 
from  May,  1821,  to  April,  1822:— 

May — ,  June  9,  July  8,  August  10,  September  9,  October  6,  Novem- 
ber 8,  December  7,  January  7,  February  14,  March  19,  April  12. 

The  number  of  rainy  days  for  May  has  been  omitted;  but  if 
eight  be  allowed,  the  number  for  the  whole  year  will  be  107.  In 
1813-14,  a  year  of  drought,  the  number  of  days  on  which  rain  fell 
was  only  61. 

From  the  general  dryness  of  the  air,  the  heat  in  New  South 
Wales  is  much  less  oppressive  at  equal  degrees  of  temperature  than 
in  England. 

In  the  winter  the  cold  is  but  little  felt  in  the  lower  parts  of  the 
colony-  bordering  on  the  sea  ;  but  in  the  interior  the  frosts  between 
night  and  morning  are  strong  enough  to  leave  upon  the  shallow 
pools  ice  of  the  thickness  bf  a  shilling. 

South  Australia. — The  climate  of  South  Australia  is  described 
as  pleasant,  except  during  the  summer  months,  when  the  heat  is 
disagreeably  great.  "  The  only  objection,"  says  Mr.  James,  "  I 
have  to  the  climate,  is  the  extreme  changes  of  temperature,  gene- 
rally three  times  a-day,  increasing  greatly  the  difficulty  of  escaping 
colds.  At  present,  for  example,  the  thermometer  in  the  morning 
may  be  about  66°;  96°  or  98°  at  mid-day;  and  66°,  or  even  lower,' 
again  by  night." 

From  the  general  dryness  of  the  air,  however,  the  heat  is  much 
less  oppressive  than  might  be  expected  from  the  height  of  the 
thermometer. 

Swan  River. — The  climate  of  Western  Australia  is  much  the 
same  as  that  of  New  South  Wales,  only  more  moist,  and  not  so 
liable  to  droughts. 

Van  Diemen's  Land. — The  climate  of  Van  Diemen's  Land  is 
free  from  the  droughts  of  the  Australian  Continent,  and  though 
cooler  is  more  changeable. 

The  following  is  the  result  of  Sir  Thos.  Brisbane's  thermometri- 
cal  observations  made  at  Hobart  Town  during  the  year  1822 : — 


January     ....  62.96 

February   .     .    v,;."',  63.14 

March 55.40 

April      .     .     .,i'v  53.60 
May.  -i.  V..£>.;  .  -45.68 

June 41.00 

July 40.10 

August 45.50 

September.     .'->7  ;;jr  47.12 


October      .  ;-;„;>     .  53.96 

November  ....  57.56 

December  .....  62.96 

Spring  .    V    . ''  "C'V.  52.88 

Summer     %,; .  t.*v  ;.v  62.96 

Autumn     ...     .  51.44 

Winter       ....  42.26 

Year  :v';':.  52.34 


168         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

There  is  little  or  no  snow ;  the  climate  is  dry ;  the  breezes  gene- 
rally become  gales,  and  when  from  the  south,  which  is  almost  daily, 
they  are  felt  to  be  very  cold.  From  October  16  to  February  23 
(the  summer  in  Van  "Diemen's  Land),  the  weather  was  as  follows : 

Rainy 42 

Strong  winds 24 

Fine  and  pleasant 28 

Very  fine '29 

Wind  too  hot 7 

Hottest  day,  25th  January,  thermometer  in  the  shade,  99i° ;  coldest 

day,  16th  of  October,  560.1 

The  climate  of  Australia  is,  according  to  all  accounts,  remark- 
ably healthy.  Fevers  are  almost  unknown,  and  the  same  may  be 
said  of  hooping-cough,  croup,  &c. 

Europeans,  enervated  by  a  residence  in  India,  become  very  much 
invigorated  and  improved  in  health  by  a  short  stay  in  Australia. 

Dysentery  is  the  most  prevalent  and  most  fatal  disease  to  which 
the  colonists  are  subject.  Few  new  comers,  it  is  stated,  escape  an 
attack  ;  and  of  the  convicts  who  die  in  tfie  civil  hospitals,  it  is  the 
cause  of  death  in  one  half. 

By  a  statistical  report  of  the  cases  treated  in  the  civil  hospital  at 
Sydney,  in  the  year  1835,  it  appears  that  the  most  prevalent  diseases 
were  dysentery,  rheumatism,  ophthalmia,  and  catarrh;  the  number 
of  cases  of  these  four  diseases  being  together  1937,  out  of  a  total 
number  of  2654. 

Catarrh  prevails  as  an  epidemic  from  time  to  time. 

Owing  to  some  deficiency  in  the  returns,  the  Military  Statistical 
Report  on  the  Diseases  of  Australia,  has  not  yet  been  completed,  but 
in  the  introduction  to  the  volume  last  presented  to  parliament  we 
find  it  stated,  that  "the  extreme  salubrity  of  the  climate  may  be 
estimated  from  the  circumstance  that  on  the  average  of  twenty 
years,  from  1817  to  1836  inclusive,  the  mortality  did  not  exceed 
fourteen  per  thousand  of  the  force  annually,  whereof  more  than  a 
fifth  part  arose  from  violent  or  accidental  deaths,  principally  attri- 
butable to  the  nature  of  the  duties  on  which  the  troops  were 
employed.  Thus  the  mortality  from  disease  alone  could  have 
amounted  to  little  more  than  one  per  cent,  annually,  being  lower 
than  in  any  other  colony,  except  the  Eastern  Provinces  of  the 
Cape  of  Good  Hope,  to  which  the  climate  of  Australia  is  in  many 
respects  similar." 

In  the  Transactions  of  the  Provincial  Medical  and  Surgical  Asso- 
ciation, a  summary  of  the  diseases  treated  in  the  Colonial  Hospital  at 
Hobart  Town,  for  a  period  of  eleven  years,  from  1821  to  1831 

1  Journal  of  a  Gentleman  visiting  Van  Dicmen's  Land  to  recruit  his  health 
after  a  lengthened  residence  in  India,  quoted  in  Swainson's  Observations  on 
the  Climate  of  New  Zealand,  a  small  work  recently  published,  giving  a 
condensed  view  of  all  the  information  we  possess  on  the  subject. 


SOUTHERN  HEMISPHERE. 


169 


inclusive,  is  given  by  Mr.  Scott.1  As  this  return  seems  to  have 
been  prepared  with  considerable  care,  it  is  possible,  from  the  pro- 
portion which  the  diseases  therein  enumerated  bear  to  the  general 
mass,  compared  with  the  proportion  which  the  same  diseases  bear 
to  the  whole  number  under  treatment  in  the  military  hospitals  at 
other  foreign  stations,  to  form  an  approximation  to  an  estimate  of 
the  influence  of  the  climate  of  Van  Diemen's  Land.  In  this  com- 
parison w.e  shall  confine  ourselves  principally  to  diseases  of  the 
lungs,  which  seem  to  be  of  rather  unfrequent  occurrence  in  that 
part  of  Australia. 


Pneumonia 

PLACES. 

CASES. 

and 

Heraoptisis. 

Consump- 

Catarrh. 

Pleuritis. 

tion. 

Hobart  Town  .  .  .  .   \ 

Out  of   ) 
30,102.   $ 

516 

98 

104 

1657 

I 

Proportion 

Iin58 

J  in  307 

1  in  290 

lin  18 

Cape  of  Good  Hope     < 

Out  of   > 
25,506.    $ 
Proportion 

673 
1  in  33 

55 
I  in  409 

125 
1  in  180 

1320 
1  in  17 

Gibraltar  ) 

Out  of   \ 
58,227.    S 

2543 

189 

394 

5186 

Proportion 

Iin23 

1  in  308 

1  in  148 

lin  11 

Malta  ) 

Out  of    ) 
46  639    $ 

1391 

106 

235 

3041 

Proportion 

Iin34 

1  in  440 

1  in  198 

1  in  15 

Ionian  Islands     .  .  .    ) 

Out  of   I 

84,438.   $ 

2272 

147 

339 

3401 

( 

Proportion 

Iin37 

1  in  574 

1  in  249 

1  in  25 

From  the  preceding  table  it  will  be  seen  that  comparatively  fewer 
cases  of  pneumonia  and  plenritis,  hemoptysis  and  consumption 
occur  in  Van  Diemen's  Land  than  in  any  of  the  other  colonies,  and 
that  as  regards  catarrh  the  proportion  of  cases  also  is  less,  with  the 
exception  of  the  Ionian  Islands. 

With  regard  to  other  diseases,  it  appears  that  fevers  are  exceed- 
ingly rare,  even  compared  with  the  healthy  colonies  above  referred 
to.  Dysentery  and  dyspepsia  very  common,  and  constipation  ex- 
tremely so  ;  while  diarrhoea  is  but  little  experienced.  Affections  of 
the  liver,  too,  are  more  rare  than  in  any  other  climate  with  which 
we  are  acquainted,  but  rheumatism  is  a  disease  of  great  frequency, 
and  also  of  more  than  usual  severity ;  and  it  is  very  remarkable, 
that  of  the  30,102  cases,  no  fewer  than  1134  were  from  toothache. 

Scrofula  and  glandular  diseases  are  rare.  Idiopathic  intermittent 
fever,  malignant  sore  throat,  smallpox,  measles,  scarlet  fever,  hydro- 
phobia, &c.  have  not  been  met  with  in  the  colony.  Hooping-cough 

1  In  regard  to  the  cases  comprehended  in  this  summary,  it  is  to  be  observed, 
that  the  greater  number  of  the  acute  diseases  were  brought  on  by  intempe- 
rance, imperfect  clothing,  and  exposure  to  wet  and  cold,  and  that  the  greater 
part  of  the  patients  were  European  convicts,  of  the  most  dissolute  habits  and 
broken  constitutions. 


170 


CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 


was  once  introduced,  and  for  a  short  time  extended  as  rapidly  and 
widely  as  in  England,  but  gradually  became  milder,  and  in  a  few 
months  disappeared,  There  have  been  no  epidemics  in  the  colony 
except  on  two  occasions.  The  first  of  these  was  an  epidemic 
influenza,  which  carried  off  many  persons  infirm  from  age;  the 
second  was  an  epidemic  continued  fever.  The  diseases,  both  acute 
and  chronic,  are-  generally  mild,  and  of  comparatively  short  dura- 
tion, and  yield  easily  to  the  usual  remedies.1 

The  frequent  and  sudden  changes  of  weather  in  Van  Diemen's 
Land  do  not  appear  to  be  attended  with  the  same  hurtful  conse- 
quences to  the  health  as  in  other  countries ;  and  it  is  remarked  by 
Mr.  Scott  that  "situations  apparently  unhealthy  are  inhabited  with 
the  utmost  freedom,  without  injury  to  the  constitution,  though  in 
any  other  country  they  would  probably  be  attended  with  inevitable 
destruction,  or,  at  least,  much  hazard  to  human  life." 

New  Zealand. — The  New  Zealand  group  consists  principally  of 
two  large  islands,  about  800  miles  in  length  and  100  miles  in 
breadth,  situated  between  48°  and  34°  of  south  latitude,  and  between 
166°  and  179°  east  longitude. 

Both  Islands  are  intersected  in  the  greater  part  of  their  length  by 
a  chain  of  very  high  mountains  perpetually  covered  with  snow ; 
hence  the  country  abounds  in  streams  and  rivers. 

The  northern  island  of  New  Zealand  appears  to  be  more  favoured 
by  nature  than  the  southern  ;  but  both  enjoy  a  temperate  climate. 

The  climate,  especially  of  the  northern  island,  is  described  by  all 
who  have  visited  the  country  as  extremely  pleasant  and  salubrious, 
and  in  every  respect  congenial  to  the  European  constitution. 

The  temperature  is  never  very  high  in  summer,  nor  very  low  in 
winter,  so  that  the  annual  range  is  within  narrow  limits.  The 
following  table  is  deduced  from  Major  Cruise's  thermometrical 
observations  made  during  the  autumn,  winter,  and  spring,  at 
various  places  on  the  west,  north,  and  east  coasts  of  the  northern 
island,  between  the  river  Hokianga  and  the  Thames. 


Mths. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Jan. 

Feb.  Mar. 

April. 

May. 

.tune. 

July. 

Max. 

64.00 

66.00 

68.00 

77.00 

74.00 

69.00 

69.00 

68.00 

62.00 

Min. 

48.00 

51.00 

51.00 

58.00 

65.00 

57.00 

50.00 

50.00 

40.00 

Mean 

57.62 

59.06 

60.48 

63.41 

69.15 

63.46 

58.80 

57.70 

52.86 

During  the  period  to  which  the  above  table  applies,  viz.  from 
March  to  November  inclusive,  86  days  were  rainy  or  showery,  78 
days  were  more  or  less  windy,  squally,  foggy,  dark,  or  hazy,  and 
150  days  were  fine. 

'A  Return  of  Medical  and  Surgical  Diseases  treated  at  H.  M.  Colonial 
Hospital,  Hobart  Town,  Van  Diemen's  Land,  for  the  Years  1-821  to  1831. 
By  James  Scott,  Esq.,  Colonial  Surgeon. — In  the  Transactions  of  the  Pro- 
vincial Medical  and  Surgical  Association,  vol.  iii.  1835. 


SOUTHERN  HEMISPHERE. 


171 


The  climate  of  New  Zealand  appears  to  be  mild,  soft,  and 
equable.  Unlike  New  South  Wales,  it  is  not  subject  to  drought 
and  hot  winds,  but  is  plentifully  supplied  with  rain,  which  appears 
pretty  equally  distributed  throughout  the  year.  The  coasts  are 
much  exposed  to  high  winds.1 

Scrofula  and  consumption  are  said  to  be  prevalent  diseases 
among  the  natives;  rheumatism,  cutaneous  diseases,  and  inflamed 
eyes  are  also  common. 

The  following  is  a  comparative  TABLE  showing  the  Mean  Temperature  of  Places 
in  nearly  corresponding  Latitudes  North  and  South  of  the  Equator. 


PLACES. 

Yearly 
Mean. 

Spring. 

Summer. 

Autumn. 

Winter. 

Funchal,in32°  30  North  Lat. 

64.56 

62.20 

69.33 

67.23 

59.50 

Malta,  in  36°  55  North  Lat. 

67.50 

63.50 

78.16 

71.00 

57.33 

Rome,  in  41°  52  North  Lat. 

60.70 

57.65 

72.16 

63.96 

48.90 

Nice,  in  43°  20  North  Lat. 

59.48 

56.23 

72.26 

61.63 

47.82 

Sidney,  in  34°  South  Lat. 

63.68 

65.57 

72.14 

62.87 

57.56 

Port  Johnston,  34°  South  Lat. 

66.56 

66.20 

80.06 

67.82 

52.34 

Cape  Town,  in  34°  South  Lat. 

66.56 

65.66 

74.30 

67.28 

58.64 

Hobart  Town,  in  43°  S.  Lat. 

52.34 

52.88 

62.96 

51.44 

42.26 

These  few  remarks  on  the  climate  of  our  colonies  in  the  Southern 
Ocean  may,  I  hope,  lead  to  the  farther  prosecution  of  the  subject, 
which  is  one  of  great  interest.  Extended  and  accurate  observations 
on  the  topography  and  climate  of  these  regions  will  not  only  afford 
positive  information  regarding  them,  but  may  correct  some  of  the 
opinions  at  present  entertained  respecting  the  causes  of  disease  in 
the  more  unhealthy  parts  north  of  the  equator.  Some  striking 
differences  in  the  influence  of  certain  localities  upon  health,  have 
been  already  observed.  It  is  remarked  in  "  The  Statistical  Reports 
on  the  Health  of  the  Navy."  that  on  the  South  American  station 
there  are  land-locked  harbours,  where,  under  a  powerful  sun,  ships 
lie  for  months,  or  years,  surrounded  by  a  country  abounding  in 
marshes  and  rank  vegetation,  and  all  the  other  circumstances  which 
elsewhere  are  considered  the  essential  cause  of  the  fevers  which 
prove  so  destructive  of  life  among  Europeans,  without  the  occur- 
rence of  a  single  case  of  fever  ;  the  crews,  on  the  contrary,  enjoying 
good  health.  Analogous  to  this  is  the  circumstance  above  quoted 
from  Mr.  Scott's  repon  that  in  Van  Diemen's  Land,  situations  which 
in  other  countries  are  found  to  exert  a  prejudicial  influence  on 
health,  have  there  no  such  effect. 


172         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

\ 


II. 


MINERAL  WATERS. 

The  influence  of  climate,  in  the  cure  of  some  of  the  principal 
diseases  treated  of  in  the  foregoing  pages,  may  be  so  effectually 
promoted  by  the  use  of  Mineral  Waters,  that  a  few  observations  on 
the  proper  application  of  these  will  form  an  appropriate  supplement 
to  this  volume.  It  is  not  my  intention  to  give  here  a  particular 
account  of  the  waters  which  I  shall  have  occasion  to  notice:  on  this 
point  the  reader  will  find  ample  information  in  the  various  works 
published  expressly  on  mineral  waters,  more  especially  on  those  of 
Germany. 

It  may  be  remarked,  in  the  first  place,  that  the  diseases  in  which 
mineral  waters  produce  the  most  beneficial  effects  are  those  of  the 
organs  more  immediately  concerned  in  digestion  and  assimilation. 
The  diseases  of  the  skin,  of  the  joints,  of  the  nervous  and  uterine 
systems,  in  which  mineral  waters  are  so  efficacious,  very  generally 
have  their  origin  in  disorder  of  the  digestive  apparatus;  and  the 
correction  of  this  constitutes  in  general  the  first  step  in  the  cure. 

Disorders  of  the  Digestive  Organs. — Although  the  favourable 
influence  of  climate,  and  a  suitable  regimen,  may  allay  irritation  of 
the  mucous  surfaces,  and  induce  a  more  healthy  action  of  these  and 
of  the  skin,  something  more  active  is  often  required  in  protracted 
and  complicated  cases  of  dyspepsia,  to  excite  a  freer  and  more 
steady  action  of  the  liver  and  other  secreting  organs  connected  with 
digestion.  With  this  view  I  consider  a  well-directed  course  of 
mineral  water  very  efficacious,  and  capable  of  effecting,  in  many 
cases,  what  no  other  remedy  with  which  I  am  acquainted  can 
effect.  Mineral  waters,  by  increasing  the  action  of  the  secreting 
and  excreting  organs,  powerfully  contribute  to  relieve  the  vessels 
from  the  load  which  oppresses  them;  and  thus  often  produce  the 
most  beneficial  effects,  not  only  in  restoring  the  functions  of  the 
affected  organs,  but  in  improving  the  condition  of  the  whole  system. 
After  a  well-directed  course  of  mineral  water,  the  dyspeptic  invalid 
enjoys  a  degree  of  activity  of  body  and  energy  of  mind  to  which  fie 
had  long  been  a  stranger;  and  if  it  be  followed  up  by  a  residence, 
during  the  following  winter,  in  a  mild  climate,  the  beneficial  effects 
may  be  increased  and  confirmed. 

But  as  it  is  with  every  other  remedy,  so  the  degree  of  benefit  to 
be  derived  from  the  use  "of  mineral  waters,  will  depend  upon  their 


MINERAL  WATERS.  173 

proper  adaptation  to  the  individual  case.  Besides,  it  is  to  be 
remarked  that  every  case  of  dyspepsia  will  not  be  benefited  by 
mineral  waters;  on  the  contrary,  many  cases  would  be  injured  by 
the  mildest  of  them. 

The  selection  of  the  particular  water  must  depend  upon  the 
peculiar  nature  of  the  derangement  and  degree  of  susceptibility  of 
the  digestive  organs,  and  upon  the  secondary  disorders  which  may 
have  been  induced  in  other  parts  of  the  system. 

When  the  mucous  surfaces  are  in  a  state  of  irritation,  and  the 
liver  and  abdominal  venous  system  generally,  are  in  a  congested 
state,  or  when  the  functions  of  the  uterus  ate  defective,  and  there  is 
not  much  relaxation  of  the  system,  the  mineral  waters  of  Ems, 
of  Vichy,  or  of  Plo?nbiereSj  will  be  useful,  particularly  the  two 
first.  In  cases  where  the  skin  is  in  an  unhealthy  state,  or  where 
dyspepsia  is  complicated  with  chronic  bronchial  disease,  and  no 
objection  exists  to  an  elevated,  mountainous  country,  Caulerets, 
among  the  Pyrenees,  will  deserve  a  preference. 

When  the  abdominal  viscera  are  in  a  more  obstinately  congested 
and  torpid  state,  and  when  there  does  not  exist  much  irritation  of 
the  mucous  surfaces,  the  waters  of  Marienbad,  Carlsbad,  and 
Kissingen,  will  be  more  useful  than  any  of  these.  When  the 
digestive  organs  are  easily  excited,  and  a  full  action  on  the  bowels 
is  required,  the  cold  aperient  waters  of  Marienbad  are  indicated  j 
when  the  digestive  organs  are  in  a  languid  state,  the  more  exciting 
waters  of  Kissingen  will  be  preferable.  The  Carlsbad  water,  in  its 
operation  on  the  animal  economy,  may  be  considered  as  holding  a 
medium  place.  In  some  cases,  a  course  of  the  Ems  water  may 
precede  these  with  great  advantage.  When  a  state  of  atony  of  the 
stomach  exists  with  general  nervous  debility;  or  when  the  uterine 
system  is  debilitated  and  relaxed,  without  there  being  any  organic 
disease,  a  cold  chalybeate  water,  such  as  that  of  Pyrmont,  or 
Schwalbach,  will  be  very  useful,  and,  in  many  cases,  still  more  so, 
if  preceded  by  a  course  of  Kissingen  water.  The  internal  use  of 
the  two  former  is  often  advantageously  combined  with  a  course  of 
warm,  bathing  in  the  same.  But  to  derive  essential  benefit  from 
this  class  of  waters,  the  digestive  organs  must  be  free  from  irritation, 
and  the  vascular  system  not  in  a  state  of  plethora.  In  many  cases 
a  course  of  bathing  at  Ems  forms  a  good  preparative  for  the  internal 
use  of  a  chalybeate  water. 

All  these  waters,  at  the  same  time  that  they  are  used  internally, 
may  generally  be  employed  in  the  form  of  bath  with  great  advan- 
tage. The  temperature,  the  duration  and  repetition  of  the  bath  can 
be  directed  only  by  the  physician  residing  at  the  place;  and  the 
same  observation  applies  to  the  duration  of  the  course,  the  quantity 
of  water  to  be  drunk,  &c. 

A  short  course  of  a  cold  chalybeate  water  may  be  employed  very 
advantageously,  in  many  cases,  with  the  view  of  giving  tone  to  the 
system,  and  confirming  the  effects  of  the  deobstruent  waters.  When 
it  is  desirable  to  keep  up  some  action  on  the  bowels,  the  waters  of 


174         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

Eger  will  answer  well;  when  the  purely  tonic  effects  of  the  waters 
are  desired,  those  of  Schwalbach  or  Pyrmont  will  be  preferable. 

From  a  well-directed  course  of  one  or  more  of  these  waters,  the 
dyspeptic  invalid  will,  T  believe,  derive  all  the  advantage  which  is 
to  be  obtained  from  this  class  of  remedies. 

After  the  use  of  mineral  waters,  a  residence  for  some  time  in  a 
bracing  air}  or  by  the  sea-side,  will  be  very  beneficial.  When  the 
intention  is  to  pass  the  winter  in  Italy,  the  journey,  if  well  con- 
ducted, is  not  likely  to  interfere  with  the  good  effects  of  the  waters; 
but  rapid  traveling  should  be  avoided,  and  whatever  is  likely  to 
excite  or  heat  the  systern. 

Bronchial  Diseases. — There  are  several  mineral  waters  on  the 
Continent  which  have  a  high  reputation  in  this  class  of  diseases. 
Ems  on  the  Rhine,  Bonnes  and  Cauterets  among  the  Pyrenees, 
and  Mont  d>Or  in  Auvergne,  are  held  in  great  estimation.  A  resi- 
dence during  one  or  two  winters  in  Italy,  and  a  course  of  one  or 
other  of  these  waters,  according  to  the  nature  of  the  case,  during 
the  summer,  afford,  I  believe,  the  most  effectual  means  we  possess 
in  the  more  obstinate  and  deeply  rooted  cases  of  bronchial  disease. 

The  selection  of  the  particular  mineral  water  must  depend  on  the 
nature  of  the  case.  Where  the  bronchial  disease  is  accompanied 
with  much  general  delicacy  of  constitution,  and  is  connected  with 
a  congested  state  of  the  abdominal  circulation,  Ems  deserves  the 
preference.  In  cases  of  less  delicacy,  and  those  especially  in  which 
a  mountain  air  promises  benefit,  or  where  the  bronchial  disease  is 
complicated  with  chronic  cutaneous  eruptions,  Bonnes,  or  Caute- 
r€ts:  will  be  more  effectual.  In  cases  where  there  exists  a  very 
torpid  state  of  the  system,  and  especially  a  languid  or  defective 
action  of  the  skin,  or  where  the  occurrence  of  the  bronchial  disease 
has  coincided  with  the  disappearance  of  any  cutaneous  eruption, 
the  system  of  bathing  adopted  at  Mont  d'Or  will,  I  believe,  effect 
cures  where  the  other  waters  fail. 

When  the  bronchial  disease  is  consequent  upon  abdominal  con- 
gestion and  disorder  of  the  digestive  organs,  a  course  of  the  Ems 
waters,  followed  by  those  of  Carlsbad,  Marienbad  or  Kissingen,  as 
the  case  may  indicate,  will  prove  the  most  efficacious  combination ; 
and  a  short  course  of  chalybeate  water  will  in  some  cases  give 
permanency  to  the  effects  of  the  other  waters. 

Asthma. — When  treating  of  asthma  in  the  first  part  of  this  work, 
it  was  remarked  that  when  the  disease  is  complicated  with  chronic 
irritation  of  the  bronchial  membrane,  or  of  the  digestive  organs,  or 
with  a  congestive  state  of  the  hepatic  system,  or  an  unhealthy  con- 
dition of  the  skin,  a  course  of  warm  mineral  water  will  prove  of 
much  benefit. 

There  is  more  difficulty,  however,  in  selecting  a  mineral  water 
for  the  asthmatic  patient  than  for  any  other,  as  the  source,  most 
suitable  in  other  respects,  may  be  in  a  situation  which  decidedly 
disagrees  with  the  asthma.  However  well  suited  the  waters  of  the 
Pyrenees,  or  of  Mont  d'Or,  might  be  as  regards  the  bronchial 


MINERAL  WATERS.  175 

disease,  it  would  be  useless  to  propose  a  residence  at  either  of  those 
places,  to  an  asthmatic  invalid  who  could  not  breathe  at  a  great 
elevation,  or  to  send  him  to  Ems  or  Carlsbad,  who  could  not  live 
in  a  valley,  although  their  waters  might  be  admirably  adapted  to 
the  bronchial  or  abdominal  diseases,  with  which  the  asthma  is  com- 
plicated. I  need  not  repeat  here  what  I  have  already  stated,  regard- 
ing the  use  of  the  mineral  waters,  under  the  heads  of  Dyspepsia 
and  Bronchial  diseases. 

When  asthma  is  complicated  with  disease  of  the  heart,  the  use  of 
mineral  waters  is  inadmissible,  and  might  be  productive  of  serious 
injury.  This  point  should  always  be  carefully  ascertained  before 
mineral  waters  are  prescribed  in  asthma. 

Gout. — The  waters  of  Ems,  of  Carlsbad,  of  Marienbad,  of  Aix-la- 
Chapelle,  and  of  Wiesbaden,  here  deserve  particular  mention. 

Used  internally,  the  waters  of  Ems  and  Carlsbad  are  well  calcu- 
lated to  benefit  the  gouty  constitution.  The  soothing  effects  of  the 
former  prove  an  excellent  preparative,  in  many  cases,  for  the  more 
exciting  but  more  deobstruent  waters  of  the  latter ;  and  these  again 
may  often  be  advantageously  followed  by  bathing  and  the  applica- 
tion of  the  douche  at  Wiesbaden,  or  Aix-la-Chapelle ;  more  espe- 
cially when  frequent  attacks  of  the  disease  have  left  the  joints  stiff 
and  swollen. 

Before  prescribing  a  course  of  mineral  waters  in  gout,  or  indeed 
in  any  other  disease,  it  should  be  ascertained  that  there  is  no  disease 
of  the  heart  or  large  vessels,  or  other  organs  in  the  chest ;  and  also 
that  there  is  no  disposition  to  cerebral  congestion. 

Rheumatism. — Climate  and  mineral  waters  are  very  efficient 
remedies  in  chronic  rheumatism.  The  baths  of  Aix,  in  Savoy, 
have  long  enjoyed  a  high  character  in  obstinate  cases  of  this  dis- 
ease. The  waters  of  Cauterets  and  Bagneres-de-Luchon,  among 
the  Pyrenees  and  those  of  Aix-la-Chapelle  are  very  beneficial, 
especially  when  the  rheumatism  is  complicated  with  cutaneous 
affections,  When  the  disease,  however,  is  symptomatic  of  a 
deranged  state  of  the  digestive  organs,  a  course  of  mineral  water, 
calculated  to  remove  this,  will  be  more  beneficial  than  any  waters 
directed  to  the  affection  of  the  joints  only.  The  cold  sulphureous 
waters  are  often  extremely  useful  in  chronic  rheumatism;  and  as 
one  of  the  best  of  the  class  in  this  country,  I  may  mention  Strath- 
peffer,  in  Ross-shire. 

FACTITIOUS  MINERAL  WATERS. 

As  many  persons,  in  whose  complaints  mineral  waters  are  indi- 
cated, must  find  it  inconvenient  to  take  a  course  of  them  at  their 
sources,  it  may  not  be  irrelevant  to  our  present  subject  to  say  a  few 
words  respecting  the  Factitious  Mineral  Waters  introduced  into 
this  country  by  the  late  Dr.  Struve  of  Dresden.  When  in  Ger- 
many, I  made  particular  inquiries  regarding  the  estimation  in 
which  these  waters  were  held  by  the  physicians  of  the  different 


176         CLARK  ON  THE  SANATIVE  INFLUENCE  OP  CLIMATE. 

cities  in  which  Dr.  Struve  had  establishments.  The  information 
which  I  obtained,  more  especially  at  Berlin,  where  these  factitious 
waters  are  extensively  employed,  was  invariabl/in  favour  of  their 
decided  utility;  and  the  remarkable  similarity  of  their  effects  to 
those  of  the  natural  waters  was  generally  admitted.  The  respect- 
ability of  Dr.  Struve,  and  his  skill  as  a  chemist,  were  also  univer- 
sally acknowledged. 

After  such  satisfactory  information,  obtained  from  physicians  of 
the  highest  character  in  Germany,  I  had  no  hesitation  in  prescribing 
the  waters  of  the  German  Spa  at  Brighton  in  the  same  cases  in 
which  I  should  have  recommended  a  course  of  the  natural  waters 
of  Ems,  Carlsbad,  &c.,  had  not  the  distance  of  these  places  presented 
obstacles  to  their  employment.  I  have  had  abundant  experience  of 
the  beneficial  effects  of  Dr.  Struve's  waters  in  the  diseases  which 
are  treated  of  in  this  work.  And  I  feel  satisfied  that  when  their 
effects  are  more  generally  known  to  the  profession,  and  the  manner 
of  using  them  better  understood,  they  will  be  extensively  and  bene- 
ficially employed  in  a  numerous  class  of  diseases,  and  especially  in 
disorders  of  the  digestive  organs,  &c.  At  the  same  time,  if  the 
patient  could  conveniently  take  a  course  of  the  natural  mineral 
water  at  its  source,  I  should  decidedly  prefer  this. 

In  one  respect,  however,  the  patient  has  an  advantage  in  taking 
the  factitious  mineral  waters,  as  they  may  be  changed  according  to 
the  circumstances  of  the  case  during  the  progress  of  the  course. 
For  example,  in  many  cases  it  will  be  very  desirable  to  begin  with 
a  mild  water,  such  as  that  of  Ems,  of  Salzbrunnen,  or  of  Saratoga, 
as  a  preparative  for  the  more  active  and  more  exciting  waters  of 
Marienbad,  of  Carlsbad,  and  Kissingen ;  and  these  again  may  be 
succeeded  by  a  short  course  of  the  chalybeate  waters  of  Eger,  of 
Pyrmont,  or  of  Spa. 

The  warm  sea-water  bath  will  in  the  greater  number  of  cases, 
promote  the  beneficial  action  of  the  waters ;  and  at  Brighton  this 
can  be  had  very  conveniently.  The  effects  of  the  dry  bracing  air 
of  this  place  will  also  contribute,  more  especially  in  relaxed  con- 
stitutions, to  the  salutary  operation  of  the  waters. 


TABLES   OF    CLIMATE. 


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NOTES  TO  TABLES  OF  CLIMATE. 


1.  PENZANCE.        (A.)  E.  C.  Giddy,  Esq.    Average  of  twelve  years,  from 

1821  to  1832  inclusive.  From  Dr.  Forbes's  Medical  To- 
pography of  the  Land's  End,  in  vol.  ii.  of  the  Transactions 
of  the  Provincial  Medical  and  Surgical  Association. 

(B.)  Annual  range,  average  extremes,  1821—1827.  Monthly 
range,  average  extremes  for  twelve  years,  1821—1832. 
Extreme  range  during  twenty-one  years,  84° — 19°=65°. 

(c.)  Mean  difference  of  7  A.  M.,  and  2  p.  M. 

(D.)  Forbes;  Climate  of  Penzance. 

2.  SIDMODTH.     Dr.  Clarke;  1812—1814;  mean  of  9  A.  M.,  and  2  p.  M.     Ed- 

inburgh Medical  Journal.  These  observations  do  not 
give  the  true  mean  temperature,  as  they  were  not  made 
with  a  register  thermometer,  or  taken  at  those  hours  from 
which  a  close  approximation  to  the  real  mean  is  obtained. 

3.  TORQUAY.       Dr.  Barry  j  January  and  February,  1838 — Dr.  Foote,  from 

December  1829,  to  July  1830,  inclusive,  and  from  Decem- 
ber 1830,  to  May  1831,  inclusive.  The  winters  of  1838 
and  of  1829-30  were  severe  ;  that  of  1830-31  mild. 

4.  UNDERCLIFF.      (A.)    Col.    Hewitt,  Drs.   Crawford,   Grant,   and   Martin, 

during  various  years  from  1829  to  1840,  including  the 
severe  winter  of  1829-30,  and  the  unusually  severe  month 
of  December,  1840,  as  also  the  mild  winter  of  1833-34. 

(B.)  Dr.  Martin,  from  two  years'  observations. 

(c.)  The  number  of  days  (144)  is  the  mean  for  1839  and 
1840,  both  of  which  years  were  unusually  wet,  especially 
1839,  when  an  almost  unprecedented  number  of  days 
proved  rainy  in  the  Undercliff,  the  number  amounting  to 
177  ;  while  in  1840,  also  a  very  wet  season,  111  days  were 
rainy.  It  should  be  also  remarked  that  under  the  denomi- 
nation of  rainy  days  is  included  those  days  on  which  ANY 
RAIN  fell  during  either  day  or  night. 

5.  HASTINGS.       Dr.  Harwood ;  from  September,  1832,  to  March,  1834,  in- 

cluding the  mild  winter  of  1833-4.  R.  Ranking,  Esq.; 
from  June  1837,  to  the  end  of  1840,  including  the  severe 
winter  of  1837-38. 

6.  CIIICHESTER.     Dr.   Sandon  ;  1794—1796.     Mean  of  8  A.  M.,  and  8  P.  M.  ; 

Cross  of  Chichester,  32  feet  above  the  level  of  the  sea. 

7.  GOSPORT.        Dr.  Burney ;  corrected  for  each  month  by  Brewster's  table, 

ut  infra. 

8.  LONDON.          (A.)  Howard  ;  from  the  observations  made  at  the  apartments 

of  the  Royal  Society,  Somerset  House,  1797—1816;  1787 
— 1816,  50°456.  Climate  of  London.  Mean  of  maxima 
and  minima,  1820—1822,  49°30.  Daniell,  Essay  on  the 
Climate  of  London.  Range  of  mean  annual  temperature 
during  thirty  years,  4°8.  Howard. 

(B.)  Deduced  from  the  average  extremes  ;  1820 — 1823.  Dan- 
iell. Maximum  temperature,  during  thirty  years,  96°; 
13th  July,  1808.  Minimum  during  the  same  period — 5°; 
9th  February,  1816-  Howard. 


NOTES.  189 

(c.)  Average  difference  of  the  higher  and  lower  mean,  1797 
—1806.  Howard.  Mean  daily  range  according  to  Daniell, 
13°6  ;  mean  maximum,  56°1 ;  mean  minimum,  42°5. 

(D.)  Mean  difference  of  the  temperature  of  the  same  hours 
of  successive  days ;  calculated  from  Daniell's  Meteorolo- 
gical Journal,  1820—1823. 

8a.  ENVIRONS  OF  LONDON,  viz.,  Plaistow,  Stratford,  and  Tottenham.     How- 
ard, ut  supra. 

^A.)  Average  extremes,  180? — 1816. 

'B.)  Average  difference  of  the  higher  and  lower  mean,  1807 

to  1816. 

9.  CHISWICK.     Horticultural  Gardens,  average  of  ten  years,  1826 — 1835 
inclusive. 

10.  BUSHY   HEATH.     Colonel   Beaufoy;    1824,    1825.     Mean   of  extremes. 

Annals  of  Philosophy. 

11.  OXFORD.         Dr.  Robertson,  Radcliffe  Observatory;  1816 — 1821;  mean 

of  maxima  and  minima.     Edinburgh  Phil.  Journal. 

12.  CHELTENHAM.     Moss;  1821,1825,  1826;  mean  of  extremes.     Thomas's 

Practical  Observations,  fyc. 

13.  BRISTOL.        Bristol   Institution;    average  of  three  years,    1834 — 1836, 

both  inclusive.  These  tables,  although  made  with  the 
register  thermometer,  are  not  so  perfect  as  could  be  de- 
sired, as  they  do  not  note  more,  than  twenty-seven  days 
in  any  month,  and  in  one  or  two  months,  so  few  as  14. 

(B.)  The  calculations  are  only  an  approximation  to  the 
truth,  as  the  quantities  were  never  noted  for  more  than 
twenty -six  days  in  the  month,  and  sometimes  only  twenty- 
three. 

(c.)  The  number  of  days  heie  given  is  only  an- approxima- 
tion to  the  truth,  as  there  were  never  more  than  twenty- 
seven  days  noted  in  any  month,  and  sometimes  so  few  as 
twenty-three.  And  the  weather  is  frequently  marked  fine 
when  the  pluviometer  indicates  a  fall  of  rain  ;  this  pro- 
bably arises  from  the  fall  having  taken  place  during  the 
night. 

14.  HELSTON,  Cornwall.     Mr.  Moyle  ;  1821—1828  ;  105  feet  above  the  level 

of  the  sea. 

15.  EXETER.        Dr.  Barham.     Average  of  eight  years,  1829  to  1836  both 

inclusive. 

16.  NEW  MALTON;  Yorkshire.     Mr.  Stockton;  1823,  1824;  ninety-two  feet 

above  the  level  of  the  sea.     Annals  of  Philosophy. 

17.  ALDERLEY  RECTORY,   near  Knutsford,  (Cheshire.)  (A.)     The  Rev.  E. 

Stanley  ;  IS  15,  1824,  mean  of  8  A,  M.,  2  p.  M.,  and  10  P.  M., 
corrected  for  each  month  by  Dr.  Brewster's  table,  as  de- 
duced from  the  Leith  Fort  Observations. 

(B.)  Average  of  extremes  of  ten  years.  Extreme  ran°e  in 
ten  years,  84°— l°r=83. 

(c.)  Mean  difference  of  8  A.  M.  and  2  p.  M.  Edinburgh 
Philosophical  Journal,  xxiv. 

18.  KENDAL.        Dalton. 

19.  BUTE.          (A.)   Robt.  Thorn,  Esq.,   of  Ascog.     Average  of  nineteen 

years,   1821   to   1839   inclusive ;   the   observations   taken 
hourly  for  twelve  years  during  that  period  ! 
(B.)  Deduced  from  the  data  in  Table  X.     See  the  following 

note. 

Note  to  Table  X.     The  maxima  and  minima  of  the  barometer  and  thermo- 
meter in  the  bottom  line,  are  the  highest  and  lowest  points 
reached  by  the  mercury  during  the  whole  of  the  19  years. 
Column  7  gives  the  greatest  difference  of  temperature  during 


190         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

the  whole  of  the  nineteen  years,  for  each  month,  and  for 
the  whole  nineteen  years. 

«  The  mean  of  the  barometer  and  thermometer,  as  given  in 

the  table,  is  not  that  between  the  maxima  and  minima, 
but  have  been  deduced  by  dividing  the  sum  of  all  the  de- 
grees, noted  during  the  whole  nineteen  years,  by  the  total 
number  of  observations  made  during  that  time. 

20.  LEITH.        (A.)  Dr.  Brewster;  from  the  valuable  observations  made  at 

Leith  Fort,  1824,  1825. 

(B.)  "The  measure  of  the  daily  change  of  temperature." 
Brewster.     Edinburgh  Journal  of  Science. 

21.  EDINBURGH.     (A.)    A.  Adie,    Esq.;    10  A.  M.,   10  p.  M.,  1824-1825;  at 

Canaan  Cottage,  one  and  a  half  miles  south  of  Edinburgh 
Castle,  three  miles  from  the  sea,  and  260  feet  above  its 
level.  Edinburgh  Journal  of  Science.  Mean  of  year, 
47°8;  Winter,  38°6;  Spring,  46°4;  Summer,  58°2 ;  Au- 
tumn, 48°4;— warmest  month,  59°4,  coldest  month,  38°3. 
Playfair. 

22.  ELGIN.       '  Observations  taken  at  Elgin  Institution,  by  common  thermo- 

meter, during  the  years  1835,  1836,  1838.  These  obser- 
vations being  made  at  different  times  in  the  day  during 
the  various  years,  are  of  course  comparatively  of  little 
value  #s  determining  the  true  mean  temperature.  1835. 
8i  A.  M.,  3i  P.  M.  ;  1836,  9  A.  M.,  9  P.  M.  ;  1838,  9  A.  M.,  3  p.  M'. 

23.  KINFAUNS  CASTLE.     Lord  Gray  :  10  A.  M.,  10  p.  M.,  5140  feet  above  the 

level  of  the  sea;  1825,  48°319;  mean  of  maximum  and 
minimum  49°048.  Edin.  Phil.  Journ.  xxiv./xxviii. 

24.  COVE  OF  CORK.     Dr.  Scott.     Average  of  three  years.     From   1834  to 

1837.  Dublin  Journal  of  Medical  Science.  The  mean 
monthly  temperature  of  Cove  for  1838  (of  which  the 
months  of  January  and  February  were  unusually  severe,) 
contrasts  advantageously  with  that  of  several  other  places 
in  Britain  for  the  same  year. 

25.  DUBLIN.      Kirwan. 

26.  COUNTY  ANTRIM.     1814.  Edinburgh  Medical  Journal. 

27.  JERSEY.         Dr.  Hooper.   Average  of  five  years.     From  1831  to   1835: 

generally  moderate  winters,  and  including  the  mild  winter 
of  1833-34. 

28.  ISLE  OF  MAN.     Average  of  five  years  from  1824  to  1828,  both  inclusive. 

These  observations  only  approximate  *to  the  true  mean, 
having  been  taken  by  common  thermometer,  at  9  A.  M. 
and  11  P.  M. 

29.  GENEVA.      (A.)  Pictet.     Mean  of  sunrise  and  2  P.M.;  1080  feet  above 

the  level  of  the  sea.     Saussure,  50°74  ;  Berne,  49°30  :  dif- 
ference of  warmest  and  coldest  month,  36°12 ;    Zurich, 
47°8  :  difference  of  warmest  and  coldest  month,  31°10. 
(B.)  Difference  of  the  mean  of  sunrise  and  of  2  p.  M.  Annual 
range  at  Sion,  92°— 9°=83°  1819,  92°-f2°=94°. 

30.  PARIS.          (A.)  Royal  Observatory;  mean  of  extremes  ;   M.  Bo  ward, 

1806—1826. 

31.  NANTES.        Huette,  Observatory;  46  metres  above  the  level  of  the  sea. 

and  25  from  the  ground  ;  1824,  1825,  55°94.  Duplessis 
and  Bondin. 

32.  BOURDEAUX.    Humboldt,  from  Guyot. 

33.  PAU.  (A.)  Mr.  Christison ;  at  Chateau  Billere,  from  September, 

1822,  to  July,  1824 ;  and  at  Pau,  Hotel  de  Place,  from 
July,  1824,  to  May,  1825. 

(B.)  Mean  difference  of  9  A.  M.,  and  noon.  Range  at  Tou- 
louse, 81°— 24°=57°. 

(c.)  Mean  difference  at  9  A.  M.,  12  A.  M.,  and  4  P.  M. 


NOTES. 


191 


34.  MONTPELIER.    Poitevin;    1796—1806.     Sur  le  Climat  de  Montpelier. 

58°  mean  of  twelve  years  ;  Mejan.  Nismes,  60°26. 

35.  AVIGNON.      (A.)  M.  Guerin  ;  Musee  Calvet;  about  seventy  feet  above 

the  level  of  the  sea  ;  sunrise  and  2  P.  M. 
(B.)  Mean  difference  of  sunrise  and  2  P.  M.     Extreme  lange 
in  twelve  years,  101°— 12° =89°. 

36.  MARSEILLES.     (A.)  Thulis  and  Blanpain,  Royal  Observatory  ;  about  160 

feet  above  the  level  of  the  sea  ;  1806—1815-     Statistique 
des  Bouches  du  Rhone.    60°10.     St.  Jaque  de  Sylvabelle. 
Aix  56°66 ;  309  feet  above  the  level  of  the  sea. 
Range  at  Marseilles,  93°— 20°=73°;  at  Aix  102°— 19°=83°. 

37.  TOULON.        M.  Burel,  Naval  Hospital;    1749—1781.     Statistique  des 

Bouches  du  Rhone. 

38.  NICE.  (A.)  M.  Risso  ;  1806—1825;  mean  of  8  A.  M.  and  of  8  p.  M., 

corrected  by  Brevvster's  Table.  Histoire  Naturelle  de 
VEurope  Meridionale.  Dr.  Skirving.  November,  1820, 
to  February,  J 826;. mean  of  sunrise  and  2  p.  M.  Both 
these  series  of  observations  nearly  coincide. 

(B.)  Dr.^Skhving  ;  mean  difference  of  sunrise  and  2  p.  M. 

(c.)  Idem  :  the  mean  difference  of  successive  days  at  sun- 
rise and  at  2  p.  M. 

39.  GENOA.        I.  Fratelli  Mojon.     Humboldt,  60°26. 

40.  LEGHORN.    (A.)  Dr.  Peebles  and  others. 

(B.)  Mean  difference,  of  8  A.  M.  and  2  p.  M. 

41.  NAPLES.       (A.)  Broschi,  Observatory  at  Capo  di  Monte  ;  148  metres 

above  the  level  of  the  sea  ;  mean  of  sunrise  and  2  p.  M.  ; 

1821—1824.  Toaldo,  63°5.  Palermo,  63°60.  Scina,  Topo- 

grafia  di  Palermo. 
(B.)  Mean  difference  of  sunrise  and  2  P.  M.     Extreme  range 

during  five  years  95° — 26°=69. 
(c.)  Mean  difference  of  successive  days  at  sunrise  and  2  P.M. 

42.  MALTA.        Army  Medico-Statistical  Reports. 

43.  MEDITERRANEAN,   General  Temperatare  of.     Mr.  Wm.  Black ;    Edin- 

burgh Philosophical  Journal,  September,  1821.  Mean 
of  three  years,  affording  a  view  of  what  temperature  a 
person  might  be  exposed  to,  sailing  indiscriminately  in 
different  parts  of  the  Mediterranean. 

44.  CORFU.         Dr.  John  Davy.    Mean  of  the  thermometer  for  the  years 

1821—27. 

45.  BATHS  OF  LUCCA.     Dr.  Todd. 

46.  CAMAJORE.     State  of  Lucca,  at  the  foot  of  the  Apennines,  105  feet  above 

the  level  of  the  sea. 
(A.)  II  Canonico  Butori ;  1777 — 1816.     Lucca,  60° 44;  forty 

feet  above  the  level  of  the  sea. 
Range  88°50 — 24°00=64°50  ;  extreme  range  in  forty  years 

99°— 18°= 81°. 

47.  SIENNA.        AtBelyidera;  1786—1791;  furnished  by  Profes.  Grotanelli. 

48.  FLORENCE.   Ximenian  Observatory,  Scuole    Pie  ;   205  feet   above   the 

level  of  the  sea ;  mean  of  three  daily  observations ;  1824 
—1825.  Temperature  within  doors  61°50,  out  of  doors 
58°75.  Humboldt  61°52.  Bologna  56°30.  Verona  55°76. 
Venice  56°48.  Padua  56°30. 

49.  PISA.  Deduced  from  several  Journals.     60°0.     Piazzini. 

50.  ROME.          (A.)  Observatory  of  the  Roman  College,  163  feet  above  the 

level  of  the  Mediterranean,  and  101  feet  from  the  level  of 
the  ground  ;  1811 — 1823.  The  mean  of  the  evening  ob- 
servation at  9  P.  M.  has  been  preferred  to  the  mean  of  7 


192         CLARK  ON  THE  SANATIVE  INFLUENCE  OF  CLIMATE. 

A.  M.  and  2  p.  M.  Effemeride  Astronomiche  60°08.  Calan- 
drelii,     63°44.  W.  Humboldt. 
(*)  It  freezes  on  an  average  about  ten  times  in  every  year,  and 

snow  falls  about  twice  a  year. 
(B.)  Mean  difference  of  7  A.  M.  and  2  p.  M.     Extreme  range 

during  thirteen  years  101° — 22°=89°. 

(c.)  Mean  difference  of  successive  days  at  7  A.  M.,  2  P.  M., 
and  at  9  p.  M. 

51.  CADIZ.        Dr.   Skirving;    September   1810  to  August  1812,  on  board 

ship  in  Cadiz  Bay,  at  noon  and  6  p.  M.,  corrected  by 
Brewster's  table;  Madrid  59°0;  2040  feet  above  the  level 
of  the  sea.  Lisbon  62°.  Balbi.  Essai  Statistique  sur  le 
Portugal. 

52.  ST.  MICHAEL'S.  Thomas  Blunt,  Esq.,  1825— Mean  of  8  A.  M.  and  8  P.M.* 

53.  MADEIRA.     (A.)  Dr.  Heineken,  Funchal:    1826.     Mean  deduced  from 

mean  maxima  and  mean  minima,  Gourlay;  mean  of  ex- 
tremes ;  1793—  J802;  mean  annual  temperature,  66°21. 
Winter,  62°53;  Spring,  63°00;  Summer,  70°50;  Autumn, 
69°20;  January,  61°40;  February,  62°20 ;  Match,  61°30; 
April,  62°10;  May,  65°60;  June*  67°40;  July,  71°10; 
August,  72°90;  September,  72°80;  October,  69°20 ;  No- 
vember, 65°60;  December,  63°00.  Heberden  67°30 ;  mean 
annual  temperature,  as  corrected  by  M.  Schouw. 

(B.)  fGourlay,  average  of  eighteen  years.  (?)  Heineken,  1826. 

(c.)  Mean  difference  of  maxima  and  minima. 

(D.)  Mean  difference  of  successive  days  at  10A.M. and  10 P.M. 

54.  SANTA  CRUZ,  Isle  of  Teneriffe,  Von  Buch,  from  the  Journal  of  Don 

Francisco  Escolar  ;  mean  of  sunrise  and  of  noon. 

55.  CAIRO.         Humboldt,  from  Nouet. 

»  See  also  Dr.  Bullar's  Observations,  p.  144  of  this  work. 


CONTENTS 


INTRODUCTION, 

General  Remarks  on  the  influence,  of  Climate  on  Disease,     - 
Traveling, 


PAGE 
11 
14 
ib. 


PART    THE  FIRST. 
ON  DISEASES. 

DISORDERS  OF  THE  DIGESTIVE  ORGANS,  -                    u  *;       17 

Gastritic  Dyspepsia,                                       -  ib. 

Atonic  Dyspepsia,     -                        -  -,'      '                  18 

Nervous  Dyspepsia,  19 

The  more  recent  and  simple  cases  of  Dyspepsia,  -                                 22 

The  more  protracted  and  complicated  cases  of  Dyspepsia,  .            25 

PULMONARY  CONSUMPTION,  .  %i,       30 

Tuberculous  Cachexy,  "- .      ib. 

Hereditary  Predisposition,  'r1       32 

Exciting  Causes,       -  .  -.••*•.'      33 

Choice  of  Climate,    -  '  -'       36 

Artificial  Climate,     -  •-        41 

Respirator,     -  43 

DISEASES  OF  THE  LARYNX,  TRACHEA,  AND  BRONCHI,  44 

ASTHMA,            -                                             '',-'>  ^      47 

Pure  Nervous  Asthma,  -        - .  *:•••      48 

Humid  Asthma,        -                                     -  ib. 

Cardiac  Asthma,       -  -        ib. 

GOUT,    -  .-48 

CHRONIC  RHEUMATISM,    -  -                    {-  <    49 

DELICACY  IN  CHILDHOOD  AND  YOUTH,  *  --         &s     i-*-        ib. 

Dyspepsia  in  Children,  -        50 

CLIMACTERIC  DISEASE,      -  '    iftfl    *  -        53 

DJSORDERED  HEALTH  FROM  VARIOUS  CAUSES,     p        -        55 

From  a  Residence  in  hot  Climates,   -  -        ib. 

Convalescence,  &c.  -                       -       ib. 

2— g  14  dark 


194  CONTENTS. 

PART  THE  SECOND. 
ON  CLIMATES. 

INTRODUCTORY  REMARKS,  -           -  ^57 

Ventilation,                -  -            -            -            -  ib 

Unhealthy  Residences,  ....  5g 

Directions  for  Invalids  making  a  Change  of  Climate,  -           -  60 

CLIMATES  OF  ENGLAND,  -           -            -           .           -  64 

LONDON,  .      ,      .  65 

THE  SOUTH  COAST,    -  -  66 

Hastings,  .            -67 

St.  Leonard's,        -  -            -  69 

Brighton,               -  -            -            -            -  ib. 

Isle  of  Wight— Undercliff,  .  70 

.  SOUTHWEST  COAST,    -  -           .  74 

Salcombe,               -  .            .  76 

Torquay,  -  ib. 

Dawlish     -  .77 

Exmouth,  Salterton.  .  ib. 

Sidmouth,  -  78 

CORNWALL,  LAND'S-END,       -  -  80 

Penzance,  -  ib. 

Falmouth,  Flushing,  -  83 

WEST  OF  ENGLAND,  -  85 

Clifton,      ...  -           -  ib. 

Bristol  Hot  Wells,            -  -  86 

ISLAND  OF  BUTE,        -  -88 

COVE  OF  CORK,                      -  -  89 

SUMMER  RESIDENCES  IN  ENGLAND,  -                                                -  95 

THE  CHANNEL  ISLANDS,  -  96 

Jersey,       -                       -  ib. 

CLIMATE  OF  FRANCE,  -  98 

SOUTHWEST  OF  FRANCE,  Pau,  -  ib. 

SOUTHEAST  OF  FRANCE,  -  101 

Montpelier,             -            -  -  103 

Marseilles,  -  ib. 

Hyeres,      ...  -  104 

CLIMATE  OF  NICE, 105 

Villa  Franca,         ...  ...  110 

Menton  and  San  Remo,     -  -  ib. 

CLIMATE  OF  ITALY,                        -  -  111 

Genoa,       -  ib. 

Florence,  •  112 

Pisa,          -  -  113 

Rome,        -                       -  -114 

Naples,      -  -  121 


CONTENTS.  195 

PACK 

CLIMATE  OF  MALTA,                                                           -           -*>  123 

SUMMER  RESIDENCE  ON  THE  CONTINENT,  *  -  *  126 

ENVIRONS  OF  NAPLES  : —        -                        -  -  127 

Capo  di  Monte,  Sorento,  Castelamare,  Cava,       V  -  ib. 

SIENNA,  -  128 

BATHS  OF  LUCCA,       -                       -        *•'•  *           -  ib. 

SWITZERLAND,  -  129 

ATLANTIC  CLIMATE,  -  130 

EASTERN  ATLANTIC,                                                                 -  -  131 

Madeira,                             -  ib. 

Canaries,                            -  140 

Azores,       -  142 

WESTERN  ATLANTIC,  -  146 

Bermudas,                                                    :  -  ib. 

Bahamas,                                         -  148 

THE  WEST  INDIES,     -  -  150 

Jamaica,     -                                     -  -  157 

Barbadoes,  -  158 

St.  Vincent,  -  ib. 

Antigua,  St.  Kitt's,  Nevis,  -  159 


APPENDIX  I. 

CLIMATES  OF  THE  SOUTHERN  HEMISPHERE,          -        ->  163 

CAPE  OF  GOOD  HOPE,  -                       -  ib. 

Cape  Town,  -  ib. 

Eastern  Province,  -  ib. 

AUSTRALIAN  CLIMATE,  -  165 

New  South  Wales,  -  ib. 

South  Australia,  -  166 

Swan  River,  -  ib. 

Van  Diemen's  Land,  -  ib. 

NEW  ZEALAND,                       -            -            -  -            -            -  170 


APPENDIX  II. 
MINERAL  WATERS. 

IN  DISORDERS  OF  THE  DIGESTIVE  ORGANS,      -  -      172 

Bronchial  Diseases,  Asthma,  Gout,  Rheumatism,  -      174 

FACTITIOUS  MINERAL  WATERS,          -  -  -  -  -      175 


196  CONTENTS. 


APPENDIX  III. 
TABLES  OF  CLIMATE,  &c. 

I.  Showing  the  mean  temperature  for  each  month,  each  season,  and  for  the 

whole  year. 

II.  Showing  the  difference  between  the  mean  temperature  of  each  season, 
and  of  each  month. 

III.  Containing-  the  annual  and  monthly  ranges  of  temperature. 

IV.  Containing  the  daily  range  of  temperature. 

V.  Showing  the  variations  of  temperature  between  each  successive  day,  for 

each  month,  and  for  the  whole  year. 
VI.  Account  of  the  temperature  experienced  by  an  invalid  confined  to  the 

house  at  Nice  and  Torquay,  compared  with  the  temperature  of  the 

external  air. 

VII.  Showing  the  range  of  the  barometer  for  each  month  and  for  the  whole  year. 
VIII.  Showing  the  mean  quantities  of  rain,  in  inches  and  parts  of  inches,  for 

each  month  and  for  the  whole  year. 
IX.  Showing  the  relative  prevalence  of  different  kinds  of  weather  for  each 

month  and  for  the  whole  year. 
X.  Meteorological  Table  for  Bute — from  1821  to  1839,  inclusive,  deduced 

from  registers  of  observations  made  (hourly  for  twelve  of  the  nineteen 

years)  at  Rothsay  Cotton  Mills,  and  at  Ascog,  by  Robert  Thorn,  Esq. 
Notes  to  Tables  of  Climate. 


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